Making a medicine out of MDMA

This commentary (2015) examines how inappropriate, non-evidence-based, legislative restrictions of MDMA have failed to mitigate the harms of recreational ecstasy use but have effectively halted clinical research for therapeutic use. They urge the regulatory authorities to re-schedule MDMA and promote research for therapeutic uses within psychiatry.

Abstract

“From its first use 3,4,-methylenedioxymethamphetamine (MDMA) has been recognised as a drug with therapeutic potential. Research on its clinical utility stopped when it entered the recreational drug scene but has slowly resurrected in the past decade. Currently there is enough evidence for MDMA to be removed from its Schedule 1 status of ‘no medical use’ and moved into Schedule 2 (alongside other misused but useful medicines such as heroin and amphetamine). Such a regulatory move would liberate its use as a medicine for patients experiencing severe mental illnesses such as treatment-resistant post-traumatic stress disorder.”

Authors: Ben Sessa & David J. Nutt

Summary

Researchers are trying to use MDMA to treat patients with post-traumatic stress disorder, but its historical association with recreational ecstasy is a hindrance. They want to move MDMA from Schedule 1 to Schedule 2 of the UK’s drug classification system.

A brief history of MDMA in medicine

MDMA, first synthesized in 1912, was used in couples therapy in the 1970s to help traumatised clients address repressed emotional memories, but was banned in the mid-1980s due to growing recreational use.

Controlled clinical trials

A recent placebo-controlled study of participants with treatment-resistant PTSD showed that 85% no longer had a diagnosis of PTSD after three sessions of MDMA-assisted psychotherapy.

How MDMA may work as an adjunct to psychotherapy

MDMA produces multiple effects, including oxytocin release, which improves bonding and raises levels of empathy. It is therefore a good candidate for facilitating psychotherapy.

MDMA appears to enhance the quality of social interactions and thereby improve relationships, as demonstrated by reduced social exclusion phenomena and enhanced levels of shared empathy and prosocial behaviour compared with placebo.

Current restrictions around the use of MDMA in the UK

MDMA was banned in the 1980s and placed into Schedule 1 of the UN convention and the Misuse of Drugs Regulations 2001. This means that MDMA is not available for clinical use and requires a special license to be used.

Safety and risks

MDMA used for therapy has no evidence of lasting physiological or psychological harm, and there is no evidence of dependence following its use clinically. Ecstasy use is also associated with low rates of clinical problems.

The risk of suicide by individuals with post-combat treatment-resistant PTSD is far greater than the risk of using MDMA in the clinical setting.

The future for MDMA research

Phase II MDMA-assisted psychotherapy for PTSD studies are happening, and Phase III studies are planned across the globe. If the UK government advisory body on drugs, the Advisory Council on the Misuse of Drugs, recommends that MDMA be placed in Schedule 2, regulations can be amended within weeks.

Conclusion

MDMA has been subject to inappropriate, non-evidence-based, legislative restrictions that have effectively held back research on clinical MDMA.