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Making a medicine out of MDMA

  • Ben Sessa (a1) and David Nutt (a2)
Summary

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.

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Copyright
Corresponding author
Ben Sessa, AddAction, 35 The Boulevard, Weston-Super-Mare, Somerset BS23 1PE, UK. Email: bensessa@gmail.com
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Greer, G, Tolbert, R. Subjective reports of the effects of MDMA in a clinical setting. J Psychoactive Drugs 1986; 18: 319–27.
2 Mithoefer, MC, Wagner, MT, Mithoefer, AT, Jerome, L, Doblin, R. The safety and efficacy of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J Psychopharmacol 2010; 25: 439–52.
3 Mithoefer, MC, Wagner, MT, Mithoefer, AT, Jerome, L, Martin, SF, Yazar-Klosinski, B, et al. Durability of improvement in PTSD symptoms and absence of harmful effects or drug dependency after MDM-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol 2013; 27: 2839.
4 Chabrol, H. MDMA assisted psychotherapy found to have a large effect for chronic post-traumatic stress disorder. J Psychopharmacol 2013; 27: 865–6.
5 Sessa, B. Could MDMA be useful in the treatment of PTSD? Prog Neurol Psychiatry 2012; 15: 47.
6 Bedi, G, Cecchi, GA, Slezak, DF, Carrillo, F, Sigman, M, de Wit, H. A window into the intoxicated mind? Speech as an index of psychoactive drug effects. Neuropsychopharmacology 2014; 39: 2340–8.
7 Frye, CG, Wardle, MC, Norman, GJ, de Wit, H. MDMA decreases the effects of simulated social rejection. Pharmacol Biochem Behav 2014; 117: 16.
8 Hysek, CM, Schmid, Y, Simmler, LD, Domes, G, Heinrichs, M, Eisenegger, C, et al. MDMA enhances emotional empathy and prosocial behavior. Soc Cogn Affect Neurosci 2013; Oct 23 (Epub ahead of print).
9 Wardle, MC, de Wit, H. MDMA alters emotional processing and facilitates positive social interaction. Psychopharmacology (Berl) 2014; 231: 4219–29.
10 Kirkpatrick, MG, Lee, R, Wardle, MC, Jacob, S, de Wit, H. Effects of MDMA and intranasal oxytocin on social and emotional processing. Neuropsychopharmacology 2014; 39: 1654–63.
11 Kirkpatrick, MG, Baggott, MJ, Mendelson, JE, Galloway, GP, Liechti, ME, Hysek, CM, et al. MDMA effects consistent across laboratories. Psychopharmacology (Berl) 2014; 231: 3899–905.
12 Carhart-Harris, RL, Erritzoe, D, Williams, LTJ, Erritzoe, D, Wall, MB, Ferguson, B, et al. The effects of acutely administered 3,4-methylenedioxymethamphetamine on spontaneous brain function in healthy volunteers measured with arterial spin labeling and blood oxygen level-dependent resting state functional connectivity. Biol Psychiatry 2014; 10 Jan (Epub ahead of print).
13 Doblin, R, Greer, G, Holland, J, Jerome, L, Mithoefer, MC, Sessa, B. A reconsideration and response to Parrott AC (2013) “Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research”. Hum Psychopharmacol 2014; 29: 105–8.
14 Selvaraj, S, Hoshi, R, Bhagwagar, Z, Murthy, NV, Hinz, R, Cowen, P, et al. Brain serotonin transporter binding in former users of MDMA (‘ecstasy’). Br J Psychiatry 2009; 194: 355–9.
15 Kemp, J, Bossarte, R. Suicide Data Report 2012. US Department of Veterans Affairs, 2013 (http://www.va.gov/opa/docs/Suicide-Data-Report-2012-final.pdf).
16 Multidisciplinary Association for Psychedelic Studies (MAPS). Protocol MAA-1: A Placebo-Controlled, Randomized, Blinded, Dose Finding Phase 2 Pilot Safety Study of MDMA Assisted Therapy for Social Anxiety in Autistic Adults. Multidisciplinary Association for Psychedelic Studies (MAPS), 2013 (http://www.maps.org/research/mdma/MAA1_FINAL_Protocol_22Feb13_redact.pdf).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Making a medicine out of MDMA

  • Ben Sessa (a1) and David Nutt (a2)
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eLetters

Re:MDMA-Hope for PTSD

Ben Sessa, Psychatrist
13 March 2015

Dear Dr Rani Pathania,

Thank you for your supportive and informative words about the fascinating, important and exponentially developing field of MDMA ClinicalScience. This is a branch of research medicine that is now really taking off. You rightly allude to the recent work of Mithoefer (2010, 2013), whose long-term follow-up study showed a sustained absence of PTSD symptoms in 20 patients with treatment-resistant PTSD four years after a single course of MDMA-assisted psychotherapy.

MDMA Therapy research is now moving into Phase Three, with large multi-centre trials beginning within the next 24 months. (More details here: http://www.maps.org/research/mdma). This includes, we hope, a UK-based arm of the project and a planned licensing date for MDMA as a prescription medicine for treatment-resistant PTSD by the year 2021. Theseare bold steps indeed. For that large population of sufferers of PTSD who remain chronic and under-treated by traditional methods of treatment (almost 50% of all sufferers!) this cannot come soon enough.

Yours Sincerely

Dr Ben Sessa

References:

Mithoefer MC, Wagner MT, Mithoefer AT, Jerome L ,Doblin R (2010) The safety and efficacy of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: The first randomized controlled pilot study. J. Psychopharmacol. 25(4): 439-452

Mithoefer et al (2013) Durability of Improvement in PTSD Symptoms andabsence of harmful effects or drug dependency after MDM-assisted Psychotherapy: A Prospective Long-Term Follow-up Study. J Psychopharmacol,2013. 27:28-39.

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Conflict of interest: None declared

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MDMA-Hope for PTSD

Rani Pathania, doctor
06 February 2015

Amphetamine ,methylphenidate, Morphine ,heroin, ketamine are all potential drugs used clinically but whenever we hear the word "MDMA" -The first though that comes in our mind is Ecstasy and Rave parties ,people behaving in odd manner and experiencing hallucination, paranoia and disinhibition. Recently there has been lot of discussion on use of MDMA intreatment of resistant PTSD ,illness that is one the psychiatric illness that very difficult to treat and getting common these days because all horrific stuff happening around us . Studies like Mithoefer et al. (2010) {2012) have found that 83% of the subjects receiving MDMA-assisted psychotherapy in a pilot study no longer met the criteria for PTSD, and every patient who received a placebo and then went on to receive MDMA-assisted psychotherapy experienced significant and lasting improvements.We are still in initial stage and only few studies have been done but results of these studies are very significant. More research in this is needed and government needs to contribute by moving it to schedule 2 lists of drugs so that more researchcan be done in this field. At the same time one has to be very careful andvigilant to make these drugs legal for therapeutic use looking into dependence risk, effect on memory, depression and chances of psychosis. More research is needed especially to look at possible harms of the drugs.It will bring more responsibility on clinician to prescribe and monitor drugs like this.Making these drugs legal is not easy but at it has happened in the past otherwise people with terminal cancer will still be suffering with pain and agony in last days of their life, people with ADHD will be suffering despite being capable of doing everything.Legalising it for therapeutic use is not only going to be beneficial for patients but also going to be beneficial for economy looking into burden and resources we use in treating resistant PTSD.

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Conflict of interest: None declared

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