How MDMA Went from Club Drug to ‘Breakthrough Therapy’
wsj.com
wsj.com
http://www.maps.org/research-archive/dea-mdma/
Having had experience with MDMA I can attest to it’s near magical therapeutic powers. But no drug is a panacea and it can certainly have drastic side effects, particularly when abused but even if not.
[0] https://www.amazon.co.uk/Ecstasy-Dance-Culture-Nicholas-Saun...
>Ex-DEA agent: Opioid crisis fueled by drug industry and Congress Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities -- knowing that people were dying -- and says industry lobbyists and Congress derailed the DEA's efforts to stop it
https://www.audible.com/pd/History/Acid-Test-Audiobook/B00MP...
I was on MDMA in 2000 when I finally saw through my own bigotry. I had been raised with a particular set of values about a group due to the prejudice of a parent. I have always attributed that personal breakthrough to the drug. This still might have occurred naturally, albeit at a slower rate, but it shattered my worldview in a very positive way in one night.
I could go on about personality changes that were directly linked to another chemical, but the point is that just because it hasn’t happened to you doesn’t mean that it hasn’t happened to someone else.
The book Trust Surrender Receive has 40+ accounts of people use did underground therapy with amazing results.
That one night was a huge, huge catalyst in overcoming my social anxiety and I can't overstate how long-lasting, life changing and valuable the experience was for me.
MDMA is an extremely powerful substance and I'm excited to see it being taken seriously for therapy.
The world we know is largely constructed by semi-conscious and sub-conscious processes, from world building processes (such as how the mind filters and modifies information to construct our reality), to conclusions we make about the world, ourselves, and what is possible (emotionally motivated reasoning, decision heuristics, predictive modeling).
Google deep dream provides interesting insight into psychedelic phenomena, and hints at what is changing in the mind’s world-building process when on those substances.
When it comes to MDMA, because it so dramatically changes emotion, it can also dramatically shift reasoning and thinking heuristics that unconsciously originate from emotion. This can transform beliefs that you once took for self-evident fact, into things that you now realize represent how you feel more than reality.
Some further reading that I found very valuable: World Building Process: https://www.ted.com/talks/anil_seth_how_your_brain_hallucina... Deep Dream: http://www.slate.com/articles/technology/bitwise/2015/07/goo...
Both have extremely high therapeutic potential, classic psychedelics in particular are interesting in the same way that space exploration is interesting.
And as diogenescynic noted elsewhere, it's even more shocking that we as a society put up with it.
A good recent example is ketamine. The drug, or, rather, the mechanism behind it, has gotten a large push research wise of late, since it was discovered that ketamine relieved depression using a mechanism that current anti-depressants do not utilize. Until further drugs are developed, "ketamine clinics" for off-label treatment-resistant depression also exist. And there really doesn't seem to be a huge issue made about them.
I would hazard a guess (unfortunately) that one of the barriers here regarding fundraising among more commercial interests is the lack of the ability to patent, which means that the rewards for making MDMA as a treatment are not as great, as far as commercial backers would be concerned. In the case of ketamine, drug companies are trying to develop chemicals that use the same mechanism, but do not have the hallucinogenic side effects (an example currently in Phase III would be Rapastinel). These efforts are able to get corporate funding. Also, MAPS is more "advocacy group" than "medical industry", not that there is a problem with that, but they might be outside the circle of what the typical drug trial fundraising process goes through.
If MDMA even remotely has a chance (the fact that it passed Phase II trials suggests this is the case), I definitely think it would be worth exploring, as current medication options for PTSD seem to largely be limited to anti-depressants (SSRI etc.). Ala ketamine, this would be a new approach.
Some definitely do. Example:
https://www.maps.org/news/bulletin/articles/420-bulletin-spr...
Just for reference, shamans refer to Ayahausca as medicine.
I don't think I've ever encountered a shroom user and I'm fine with studies. I really don't like MJ because it does ruin people's lives around here, but I get the legalization (well, sorta, kinda legal) and I guess some people can handle it fine putting in the same boat as alcohol for me. I'm a bit perturbed because we just got smoking down and now something that smells worse is here. I was hoping people would flock to some vaping solution[1], but we got smokers who can cause a contact high. As a North Dakotan who remembers some history, I look forward to hemp being grown again in the northern plains.
I live in a place where people have stolen hand soap and drained air conditioners to get a buzz, so please forgive my default is "not good".
1) whatever idiot thought e-cigarette was a good name should be held to ridicule.
I feel that certain groups of people are a bit flippant about drug use, and seem eager to promote them as these great things.
As an example of why we should still remain vigilant - studies have shown MDMA users to literally have shrunken bits of their brain. http://www.maps.org/news/media/2462-media-reports-of-ecstasy...
I remain cautious of people that promote these things - we should know about the side effects so we can make informed decisions.
Overall, I think it's good to open up laws to allow usage of this, but let's not forget the people who suffer from or may be prone to suffer from drug abuse, and maybe think twice before promoting these things to friends.
> Additional commentary: Upon examining this report, human neuroscience researcher Matthew Johnson noted that the researchers did not do a convincing job at "matching" the ecstasy users and control participants on other drug use. The ecstasy users had considerably more use of other drugs, but the statistical tests of whether the groups differed in this respect lacked sufficient power to detect differences in drug use.
I only had a chance to skim that article, but it is equating tablets of ecstasy with MDMA, which is a false equivalence. "Ecstasy tablets" usually contain some MDMA, but can also contain a whole bunch of other shit, including cocaine, heroine, speed, MDA, etc. I think the jury's still out on whether pure MDMA has the same downsides from frequent use.
AFAIK, the LD50 of MDMA isn't known, but as a frequent recreational user I can tell you that taking over 2000mg in a single night is definitely not common. I know a lot of people who use recreationally on a frequent basis, and none of them will go over 400mg on a night, and even 400 is considered pretty bonkers. Most folks who use every weekend are probably pretty new to the experience and haven't noticed the side effects when using more than once per month.
The most common additives are caffeine and methamphetamine, but 50%+ of the time, the pills are uncut MDMA. And these stats are distorted pessimistically, as people who are confident in what they are buying aren't likely to send drugs they paid for off to be tested.
It could be that MDMA abuse just has negative affects versus something in a controlled setting for therapy.
I was a mess as a human being for a big chunk of that time frame, but ten years later I’m a senior software developer making very good money, with a wife and kids. As far as I can tell, I’ve had zero long term negative effects from years of poly drug abuse, even though if you had talked to me at the time, you’d have thought I was a drug casualty. (Though I was working as a network engineer and getting promotions and raises the entire time.)
I wouldn’t _recommend_ going crazy with it like i did, but part of the problem I had was that all of the scare tactics I had heard were transparent lies, and the real issues around drug use were much more subtle that I had need prepared to look out for.
During my final years of the university I had spent 1 to 2 years being absolutely stoned - even had the same routine described in Infinite Jest, where I would plan for the week, how much and when should I smoke.
Over that time those who would notice me being sober would assume I was actually stoned, due to the visible changes in my behaviour. Again, not a single person knew me sober: not coworkers and neither any of my friends.
I had successfully finished the university since then and I am currently working a senior software engineer in London City.
Neither would I recommend trying the same - but what I did learn was that anything officially stated about that drug is way far away from the truth, and that _is_ the problem. The devil is in the subtleties.
It's extremely unlikely that a single dose of MDMA will cause lasting brain damage.
What is problematic, however, is that it's probably much more of a gateway drug than, for example, grass. The path from MDMA to Speed to Meth is shallow enough that some non-neglible percentage of people will probably follow it.
Not everyone, obviously. But if it's 2% or 3%, that may not be worth it.
which leads to the only logical conclusion that you should totally try MDMA if you're the type of person that would never try MDMA :)
As opposed to MDMA grass doesn't have the full-blown in-your face effects. Just as it's way easier to become an alcoholic by drinking a few beers daily than by getting drunk off a bottle of vodka.
Moreover - the potential for abuse with grass here is way wider, since it's not that easy to come to work with the MDMA eyeballs, while getting a few puffs during lunchtime isn't such a big deal in certain professions.
The problem with drugs are the people who never tried them - rather than at least just shutting up and voting to legalise the research (to look at the maths), they end up with the same discussion having little evidence _every_single_time_.
Also it gets you into the whole party lifestyle. I've personnally used it only twice a few years ago, but the people I took it with (most of us first timers) now spend a huge amount of time planning their trips and talking about drugs, and moved on to LSD and different mixes. Tbh I think it's sad that this has become such a big part of their fun. I enjoyed it, and it definitely changed me, but even though I don't worry at all for them, I don't think that's a very sane way to spend week ends.
I've never been interested in smoking weed, and my edible experience was not fun enough to encourage me to continue there either. But still, I didnt feel so "close" to the drugs world when I was hanging around stoner friends than party-goers.
Many drugs have powerful side effects — but we balance those effects against benefits. Chemotherapy is poison, yet it’s judged to be better than cancer, to take an extreme example.
This site has an overview of where MDMA and classic psychedelics may be useful, and the most effective things you can do to help the science + safe access progress: http://www.rethinkpsychedelics.org/
But yes, we're very much realizing that DEA scheduling is not based in evidence (and actually prevents gathering of further evidence).
It hammers your liver really hard, especially in combination with alcohol. In fact, it's the foremost cause of acute liver failure in the entire western world.
The kicker: it doesn't even work very well. Other pain relievers are much more effective, and have a much higher margin of safety.
But of course and critically at the same time the user should have the right thought processes in place for it to be effective and not something they cling too in a recreational cycle, in my mind it should only need to be one-time event.
The main barrier by far is funding, which my understanding is mostly comes from large (6-7 figure) funders.
So, some "opposition":
- Apathy
- Desire to not spend money / pass on majority of wealth to future generations
- Lack of knowledge
- Belief that donating to MDMA/psilocybin research isn't an effective way to donate money
I think the biggest one is just wealthy people, understandably, are hesitant to donate their money. Logically it seems many of them understand that they won't be able to spend through it all and will still have substantial resources for future generations, but emotionally I imagine it would be hard to cut a $5 million check to a non-profit.
I don't think it's a lack of billionaires aware of MDMA - there should be more than enough billionaires from the burning man crowd alone.
edit: I'm not saying it's bad to treat MDMA as a useful therapy. I'm just saying what force was at play to change the cultural opinion.
I normally would have banned a new account that posted like this, but https://news.ycombinator.com/item?id=15406879 looks pretty good, so we'll assume you want to use HN as intended. Please do read those guidelines though!
The first is the very high cost ($ billions) of getting through FDA approval for a drug. Once a company has done this approval, then other companies must show drug equivalence in order to produce generics that can stand in. They have to wait for the patents to expire, or figure out how to get around existing patents, but that's still not enough. They must show that their drug is equivalent to the existing drug. But this is not easy task, because the incumbent will do everything they can to prevent anyone else from getting the drug for research purposes. (e.g. the incumbent will claim that a particular company trying to get the drug does not fit their safety protocols, and thus refuse to provide the drug. Because the company cannot get access to the drug, they can't prove equivalence.)
Another method is that a prescription for one drug does not always guarantee that the prescription can be used for a generic drug of the same sort [0]. The incumbent company will spend lots on marketing by buying lunch for doctors, giving them notepads and pens, etc. Then, the doctor will write a prescription for that drug as write "Dispense as Written." This prevents the pharmacist from providing a generic alternative, even if they're biologically equivalent!
A final method is to develop a drug with a particular injection mechanism. For instance, if a drug company puts MDMA in a patch, then they can get a patent for the combination MDMA + patch, get approval, and then get doctors to prescribe it. (Maybe it provides a small dose over a long period?) This can occur even if MDMA was first synthesized a century ago. The prescription for the patch cannot be used for a pill form, or vice versa. This guarantees the drug company revenue as long as they can convince doctors to prescribe it.
So, to make a long story short, there are a lot of ways that drug companies guarantee their $$$ and prevent competitors from eating their lunch.
[0] https://www.washingtonpost.com/national/some-doctors-insist-...
The drug development ecosystem in America makes me sad.
First off, getting a new drug approved is not "preventing generics". Generics need a new drug approve before they can get their generic approved (since they based their application off the original drug's data). This is a feature, not a flaw of the system. Without some guarantee of market exclusivity, nobody will spend on R&D to get approval.
Second, yes, a doctor can write "DAW - dispense as written", however most insurance companies won't cover the originator drug if a generic is available. The patient is then on the hook for the entire cost. That's a strong incentive to go generic.
Finally, unless the new administration method (patch, etc) has some benefit over the generic, doctors won't prescribe it and insurance company's won't cover it.
I've heard rumors of the insurance companies backing off of this stance in the past few years. Essentially, since the ACA puts a hard cap on profit margins, insurance companies are looking for ways to spend more so they can have the same margins on a bigger pie and still increase real profit year after year. Policies like relaxing generic vs proprietary let's them achieve that in a controlled manner.
Just look at the telecommunications industry.
Small modifications can have that effect. It's why we see so many sulfonamide drugs... small modifications that increase the efficacy of the drug.
They use specific salts and specific isomer ratios in order to make it patentable.
Also, beware of false causation. The (extremely detrimental) effects of pain were not well circulated in the medical profession in the '80s. The more aggressive pain management that has occurred since is at least in part due to this sea change, and not merely "aggressive marketing". The "changes in government recommendations" did not occur by happenstance, nor were they solely motivated by pharma marketers.