Legalizing MDMA-Assisted Psychotherapy for the Treatment of Trauma-Related Mental Health Disorders
Revue YOUR, 2021, Review 8, 51-61
3, 4–methylenedioxymethamphetamine, or MDMA as it is commonly known, is classified as a “Schedule 1” substance in Canada and the United States. For decades, the compound has been shrouded by the stigma of being a dangerous party drug thought to kill brain cells and be severely addictive. However, when it was originally discovered, it was experimentally used in clinical settings as an adjunct to therapy. This idea is now resurfacing as researchers are turning back to MDMA as an innovative way to treat trauma-related mental health disorders like post-traumatic stress disorder. Considering the limitations of existing treatments for trauma-related disorders, MDMA’s pharmacological and psychological effects, and the growing body of methodologically sound research on MDMA-assisted psychotherapy, legalizing this type of therapy could provide much-needed relief to people struggling with the severe, painful, lifelong effects of trauma and related psychological disorders.
Keywords : 3, 4–methylenedioxymethamphetamine (MDMA), MDMA-assisted psychotherapy, trauma, treatment-resistant, post-traumatic stress disorder (PTSD)
In Canada, the lifetime prevalence of post-traumatic stress disorder (PTSD) was once estimated at 9.2%, with the current PTSD rate being 2.4% as of 2008 (Ameringen et al., 2008). In fact, trauma itself has been identified as a public health issue with effects that cascade from the individual through to their relationships, the community, and even society (Magruder et al., 2017). Post-traumatic stress disorder is one of the most common and severe instances of trauma, causing high rates of disability and impaired daily functioning. In the United States, missed days at work due to PTSD resulted in losses in productivity once estimated to be over $3 billion dollars (Kessler, 2000). There is even some evidence that substance use disorders may also be strongly related to PTSD (McDevitt-Murphy, 2010). Although reasonably effective pharmacotherapies and psychotherapies are being used to currently treat this disease, recent meta-analyses reiterate the need for more effective treatments, especially for treatment-resistant populations (Foa et al., 2013; Puetz et al., 2015; Watkins et al., 2018). In response to this critical need, certain researchers are turning to more controversial methods to treat trauma and its related disorders. 3,4-Methylenedioxy methamphetamine (MDMA)-assisted psychotherapy is one of these methods used to treat PTSD and based on the results of studies testing this approach, additional studies examining this new therapeutic intervention should be funded and supported by governments and academic institutions. Considering the shortcomings of current treatments, MDMA’s documented physiological and psychological effects, and the results of studies measuring the efficacy of MDMA-assisted psychotherapy, MDMAassisted psychotherapy is emerging as a revolutionary treatment for trauma that should be legalized for clinical use.
MDMA, or as it is colloquially referred to, “Molly” or “Ecstasy,” is classified as a “Schedule 1” substance in Canada and the United States (Ameringen et al., 2008; Danforth et al., 2016). For decades, the compound has been shrouded by the stigma of being a dangerous party drug that can cause neurotoxicity (Danforth et al., 2016). However, when it was originally discovered, it was experimentally used in clinical settings as an adjunct to therapy (Greer & Tolbert, 1986). This approach is now resurfacing as researchers are reconsidering MDMA as an innovative way to treat trauma-related mental health disorders like PTSD (Danforth et al., 2018; Mithoefer et al., 2011; Oehen et al., 2013; Ot’alora G et al., 2018). Alexander Shulgin, a chemist, was the first to report the psychological effects of MDMA as he explored its ability to induce controlled altered states of consciousness (Amoroso, 2015; Greer & Tolbert, 1986). After this, Dr. George Greer and Requa Tolbert were the first people to study MDMA and administer it in a clinical setting (Greer & Tolbert, 1986). Before this, throughout the mid-1970s, MDMA was legally provided by mental health professionals to thousands of people as a complement to therapy. Although positive effects were reported anecdotally, no methodologically sound research was published (Danforth et al., 2016). Amid mounting concern about the abuse potential of MDMA and the ongoing “War on Drugs” sparked by President Nixon in the United States, MDMA was labeled as a “Schedule 1” substance (Cutcliffe, 2014). The studies and literature in the decades to follow largely focused on whether the use of MDMA could result in neurotoxicity and brain damage (Danforth et al., 2016).
Although the stigma of its street reputation touted MDMA as a dangerous, addictive drug, all subjects in Greer and Tolbert (1986) reported some benefit from the experience. The majority of subjects reported a variety of cognitive improvements, including a more open worldview, insight into one’s personal patterns as psychological issues, and even an enhanced ability for self-examination. The methodology from Greer and Tolbert (1986) differed from other studies as the dosage was controlled and used in conjunction with psychotherapy. Decades later, studies have begun to build on this model by administering MDMA as an adjunct to psychotherapy for small samples of people suffering from various levels of trauma; with results indicating lasting and significant improvement in the subjects (Bouso et al., 2008; Mithoefer, 2011). This begs the question of whether this compound should be legalized to help those suffering from PTSD and other trauma-related diseases. Based on the limitations of current treatments, the indications that MDMA is physiologically and psychologically tailored to treat trauma, and the growing body of sound research demonstrating high efficacy rates for MDMA-assisted psychotherapy, legalizing this innovative intervention could be a positive step in alleviating the suffering of people struggling with severe trauma-related mental health issues.