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America holds back MDMA therapy

Has rave culture stigmatised MDMA use? Credit: Getty

June 8, 2024 - 5:30pm

“Welcome to the Psychedelic Twenties!” announced Rick Doblin, dressed in an all-white suit. He was speaking last June at the Psychedelic Science conference in Denver, sponsored by the organisation he founded, the Multidisciplinary Association for Psychedelic Studies (MAPS). That was nearly a year ago. Now, he finds himself fighting for his life’s work.

Doblin has long been at the forefront of the “psychedelic renaissance”, pioneering a series of studies seemingly showing the potential of MDMA, or ecstasy, to treat post-traumatic stress disorder (PTSD). though his New Age approach has provoked some scepticism. Earlier this week, however, the advisory board of the United States Food and Drug Administration (FDA) voted 10-1 against approving MDMA as a medicine, dashing the hopes of ravers and therapists alike.

We’ve been here before. Therapists used psychedelics in the Fifties, and it was only the backlash to the trippy-hippy counterculture that got them banned in the following decades. But the FDA’s decision is still significant for the future of MDMA. As shares for companies investing in such medicines plummet, could this be the end of the psychedelic renaissance?

When Doblin founded MAPS in 1986, MDMA-assisted therapy was supposed to be a Trojan horse for mainstreaming other psychedelics. “MDMA is a tool, and it can be used in many different ways,” Doblin told me last year. “The two-part strategy we have is drug development and drug legalisation and regulation: it should be legal for everybody. It’s very important to keep in mind that our fears of the exaggerated risks of these drugs and the counterproductive drug war have come at enormous cost. And when we think about costs, we almost never think about the things that didn’t happen: millions of people could have had phenomenal experiences on the dance floor, and hundreds of thousands of suicides could have potentially been prevented.”

As ecstasy, the drug’s euphoric properties are of interest to therapists helping patients face their fears without being overwhelmed: 71% of trial test subjects no longer met the criteria for PTSD at the end of the most recent study run last year by MAPS. But the FDA took issue with the experiments’ lack of “blinding” — because of MDMA’s intense psychoactive effects, it would be difficult for a control group to not know they’d received a dud — and alleged ignoring of serious side effects.

“I believe in the therapeutic potential of MDMA, and I used to be a MAPS supporter and volunteer,” Neşe Devenot, a senior lecturer at Johns Hopkins University, told me. “Over time, however, I noticed a distinct pattern of MAPS leaders covering up harms and lying at the expense of victims.” She added: “This clearly conflicted with their claim to having the answer to trauma. I have experienced the benefits of psychedelics firsthand, and psychedelics deserve to be the focus of rigorous research. I hope that this is a wake-up call for the field to pay attention to the quality of its research and the integrity of its behaviour.”

Not all is lost, though. “It’s not the final decision,” said Dr Stephen Bright, a drugs expert at Edith Cowan University in Perth, Australia, where MDMA and psilocybin (or magic mushrooms) therapies were legalised last year.

“With the application [to reclassify] MDMA and psilocybin [in Australia], the first application was denied at the both the interim and final decision, and the second application was disapproved at the interim decision, and then the TGA [Therapeutic Goods Administration] did a 180 and approved it in their final decision,” Bright told me. “If the FDA ultimately decides not to approve MDMA , I think the world’s eyes will be more focused on Australia and what’s happening here, and perhaps we might see more investment in psychedelic companies in Australia as a consequence.”

In January, a Melbourne doctor named Ted Cassidy wrote the first ever non-research medical prescription of 180mg MDMA for a woman with chronic, treatment-resistant PTSD. Overall, rollout across Australia has been slow but steady. There are still only a dozen licensed therapy providers across the whole country, and a course of treatment can be shockingly expensive — 30,000 Australian dollars, or over £15,000. Outside the States, there have also been promising studies into MDMA therapy in Britain. Despite the FDA’s ruling, we might not be out of the Psychedelic Twenties yet.


Niko Vorobyov is a freelance journalist and the author of Dopeworld.

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Will K
Will K
9 days ago

Anyone with a family member having a medical problem that is difficult to treat, will surely hope the medical community will not be prevented from evaluating ALL drugs for possible beneficial properties. And I feel any patient who wishes to use ANY drug they feel may benefit them, should not be prevented from doing so.

UnHerd Reader
UnHerd Reader
9 days ago
Reply to  Will K

This is an an absolutely vacuous statement.

Roddy Campbell
Roddy Campbell
7 days ago
Reply to  UnHerd Reader

Maybe explain why you think it is, rather than slinging mud?

Utter
Utter
5 days ago
Reply to  UnHerd Reader

Oh the irony.

Arthur G
Arthur G
9 days ago

I have a hard time thinking what America needs is more drugs. Pot use is soaring, with a slew of negative effects, especially for teens. 20% of people are taking psychoactive drugs. Yet, mental health is worse than it’s ever been. We have record suicides, and 100,000 over dose deaths a year.

Billy Bob
Billy Bob
9 days ago
Reply to  Arthur G

Maybe a spot of ecstasy would cheer the nation up a bit then?
It always did me, until the next morning anyway

Arthur G
Arthur G
9 days ago
Reply to  Billy Bob

8 shots of whiskey will do the same. Until the morning. Which is the whole point.

Billy Bob
Billy Bob
9 days ago
Reply to  Arthur G

Do both. Now that would be a night to remember!

J Bryant
J Bryant
9 days ago
Reply to  Arthur G

I used to do drug development for a living (and by “drug” I mean molecules that treat diseases, not recreational drugs that provide some sort of high). I’m open to the use of strongly psychoactive drugs to treat diseases otherwise resistant to treatment. For example, the active ingredient in marijuana has been shown to significantly (sometimes profoundly) reduce the severity of Crohns Disease (and other inflammatory diseases of the gut) in some treatment-resistant patients, especially in young people.
I don’t regard these molecules as curealls. They should be approved for limited use in otherwise treatment-resistant patients. I hate to see them banned completely for political reasons.

Arthur G
Arthur G
9 days ago
Reply to  J Bryant

Unfortunately, to date, psychoactive drugs have been mostly used to treat restlessness in teen boys, and sadness in teen and early 20’s men and women. In other words to treat life, not a disease.

Martin M
Martin M
5 days ago
Reply to  Arthur G

Alcohol can have negative effects too, but nobody has a problem with that.

Chris Milburn
Chris Milburn
8 days ago

When laudanum was developed it was purported to be a psychiatric cure-all. Then anti-psychotics. Then benzos. Then tricyclics. Then SSRI’s. Then…
If folks haven’t figured it out by now, our mental health crisis is existential. It’s not from a deficiency of the right drug to treat those who are increasingly disconnected, disenfranchised, and depressed.
The solution to this crisis is not going to be found at the bottom of an empty pill bottle.

Arthur G
Arthur G
8 days ago
Reply to  Chris Milburn

Exactly. You have to find meaning in something. God, country, family, friends, career. Otherwise life is a hollow slog.

Utter
Utter
7 days ago
Reply to  Chris Milburn

Both things can be true at the same time – and in this case they are. This is well understood – in 40 years of working the menal health, I’ve not come across a single professional who thought that pills are a solution. Back on to the subject at hand – many, I’d guess millions, have realised profound truths under MDMA/LSD/Psilocybin. Experiences that helped them turn their life around, or deepen their apprecation – starting with figures such as Aldous Huxley, Cary Grant, Richard Alpert, Ken Kesey. Unfortunately, the power of such drugs became unharnessed in the TIm Leary period, and a reactionary Niixon White House banned them totally. Funny to think that Nixon, and the ‘government elite/blob’ claimed Leary to be the most dangerous man in the USA, the greatest threat to young people; whilst simultaneously sending tens of thousands of young Americans to their graves in a war which did tremendous damage to America’s confidence and standing, right up to the present day – a national disaster second only to Jim Crow.

Martin M
Martin M
5 days ago
Reply to  Chris Milburn

Most people aren’t going to find it in a church either. In earlier more superstitious times perhaps, but not now.

Martin M
Martin M
8 days ago

We in Australia are making progress in this area, as the article states. Progress can be made in different countries at different times. Australia is more advanced than the US in medical use of MDMA, whereas the US is more advanced than Australia in the legalisation of cannabis.

Ted Glen
Ted Glen
7 days ago

It would help if the lead scientists researching these effects weren’t, so often, past or current casual users. It provides easy criticism of conflicts of interest bias.

Martin M
Martin M
5 days ago
Reply to  Ted Glen

I’m not sure why that makes a difference. The use of such substances medically is quite different to recreational use.

El Uro
El Uro
8 days ago

The author is a former drug dealer.