Mention the “love drug” Ecstasy and it conjures up images of young people at rave parties on the beach. But MDMA, the chemical compound better known as Ecstasy, is now gaining credibility as a potential treatment for severe trauma.
The promise of MDMA (known to scientists as 3,4-methylenedioxymethamphetamine) as a therapeutic treatment was part of a conversation between Dr. Gabor Maté and pioneers in the field who are researching the synthetic drug to treat the painful manifestations of entrenched trauma. The conversation was part of a week-long series in June featuring online discussions about trauma with experts led by Maté, whose life’s work was highlighted in the accompanying premiere of Zaya and Maurizio Benazzo’s film “The Wisdom of Trauma.” (You can sign up for an all-access pass here for $197, which includes access to the film; a recording of a 7-hour course with Maté, and 14 hours of expert discussions on trauma.)
Maté is a Hungarian-born Canadian physician who is an addiction medicine specialist, trauma specialist and author of four books, including In the Realm of Hungry Ghosts: Close Encounters With Addiction. For the conversation about MDMA, Maté spoke with Rick Doblin, a psychotherapist and the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS); Marcela Ot'alora G., MAPS’ principal investigator for MDMA-assisted therapy research, and Françoise Bourzat, the co-founder of the Center for Consciousness Medicine.
The latest study funded by MAPS, which was published this May, has made headlines in the New York Times and elsewhere. It found that MDMA, combined with talk therapy, significantly helped alleviate the symptoms of severe post-traumatic stress disorder (PTSD) in approximately half of 90 patients who received three therapy sessions while under the influence of MDMA over an 18-week period. They were compared to the same number of patients who received therapy with a placebo, according to the study that appeared in the journal Nature Medicine. After the study ended, 67% of the participants who received MDMA along with therapy no longer met the criteria for PTSD, compared to 32% of participants in the control group.
Maté and his guests talked about the politics of doing research in psychedelics, how psychedelic drugs promote healing, and some of the potential barriers in access to psychedelic treatment.
Doblin, whose interest in the healing potential of psychedelics dates back to his college days in the 1970s, noted that he was very strategic about how he decided to select MDMA as the drug to study.
To begin with, Doblin thought MDMA would be assured a better chance of getting buy-in from therapists. “MDMA is the most gentle of all the psychedelics,” Doblin said. “It's the easiest to integrate. It's the least different from normal consciousness.” And rather than therapists only being observers, Doblin declared they also needed to be participants and, during their training, to use MDMA before prescribing it to their patients.
“If they're going to really be as effective as they could be, it helps for them to do the drugs that they're going to give to other people,” he said. “And in psychiatry and psychotherapy, I felt there would be more resistance to trying psilocybin or ayahuasca [a psychoactive tea] or anything like that.”
Doblin recounted to Maté that the “War on Drugs” stigmatized and demonized drug users. MAPS settled on PTSD as the affliction that it would research to get beyond those prejudices.
“We needed a highly sympathetic patient population, and so on the one hand, there were veterans, firefighters, first responders, police officers, that people in America in particular have a kind of reverence for,” he said. “And then on the other hand are women who have been sexually abused or assaulted, and there's a lot of sympathy for them as well.”
Another consideration was how well currently approved treatments work for the condition under study. With PTSD, Doblin explained, while available treatments have worked for some people, there are still many people with PTSD who suffer intensely from the disorder.
What makes MDMA so useful in easing the grip of PTSD, explained Doblin, is a combination of changes it induces in the brain. They include turning down the threat signal that causes people with PTSD to be triggered into fight, flight or freeze, and instead flooding the brain with oxytocin, considered a “love” hormone associated with empathy and relationship building.
“When you've been traumatized by people, you tend to lose your faith in everybody,” Doblin said. “There’s always distrust. MDMA builds trust and [an abundance] of self acceptance.”
Looking back at MDMA’s popularity as an underground therapy decades ago, Doblin recalled witnessing its profound effect on helping Ot'alora overcome her own PTSD from an assault after she used it therapeutically in the mid-1980s. “Marcela kept getting better and better and better,” he recalled. (Doblin talked about their first encounter in a recent radio interview on National Public Radio.)
Maté asked Ot'alora about what it is about psychedelics that allows people to approach trauma in a different way. Ot'alora, who now provides MDMA-assisted psychotherapy, talked about the experience of her own healing. “What it provides,” she said, “is a sense of looking at all your parts that have been marginalized, and welcoming them, and being able to begin a relationship with them.”
Bourzat, too, experienced a shift: “I was carrying a huge amount of trauma from childhood and from other major traumas, and MDMA dislodged the freeze response in my body.”
Maté mentioned a discussion he had with Michael Pollan, who wrote a seminal work on the therapeutic properties of psychedelics called How to Change Your Mind, which was extremely popular. When he asked Pollan why, Maté said Pollan attributed it to the failure of so many treatments for mental health.
Maté, however, suggested that psychedelics in therapy were not a panacea. There’s a messianic belief among many people, he said, that “if only psychedelics were legalized, our problems would be solved. But let’s say all of them are legalized and a lot of people are trained in their use—they’re so bloody expensive.” He cited a couple of examples: $250 a night to participate in an ayahuasca ceremony. MDMA requires two therapists for four sessions, a costly proposition. “How will a lot of people ever have access to it?” he asked.
Doblin agreed that most people could not afford such therapy on their own. “First off, we have to have insurance coverage for it,” he said. “We’ve been able to demonstrate in initial studies that it’s cost effective, so it would pay for insurance companies to cover it. We also need to have universal health care, so everybody is covered. And that’s going to take a long time.”
Concluding the program, Maté asked his guests what their hopes are for psychedelics in the near future. Ot’alora said she was looking forward to continuing research on MDMA and educating the public and more therapists about it, and ultimately to opening a teaching clinic on psychedelic-assisted therapy and to work with underserved populations.
Doblin said researchers hope to get approval from the Food and Drug Administration for widespread MDMA use in therapy in 2023.
Bourzat mentioned a recently passed law in Oregon that created a regulatory framework to legalize psilocybin for therapeutic use after a two-year education and development campaign.
“I see the Oregon initiative serving as a template for other states,” she said, “for people who have trauma, who have addictive patterns, which is a result of trauma [or]depression—and for people who are curious to expand consciousness and change the mentality in society in general.”
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