#65 - Rick Doblin, Ph.D.: MDMA— the creation, scheduling, toxicity, therapeutic use, and changing public opinion of what is possibly the single most important synthetic molecule ever created by our species
Aug 5, 2019
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Rick Doblin, Ph.D., founder and executive director of MAPS, discusses the potential of MDMA as a therapeutic tool for PTSD. He debunks exaggerated risks associated with MDMA and highlights the progress made in getting FDA approval for a psychotherapy technique. The discussion explores the history of psychedelics and the need for their reevaluation. The chapter also touches on the FDA's approach to therapeutic protocols, Rick's journey with LSD, and the historical background of LSD.
MDMA has potential therapeutic benefits for PTSD and can create a safe space for emotional exploration and communication.
MDMA faced criminalization efforts in the 1980s but showcased its medical value in treating mental health conditions like PTSD.
MDMA-assisted therapy does not cause hallucinations but enhances empathy and emotional openness, leading to successful treatment of PTSD and depression.
MAPS has been working for 30 years to legitimize MDMA as a therapy for PTSD and is close to FDA approval.
Psychedelics like LSD and psilocybin have shown promise in therapy and efforts are being made to establish licensed psychedelic clinics for therapeutic use.
Deep dives
The therapeutic potential of MDMA
MDMA, also known as ecstasy, has shown potential in therapeutic settings. It has been used in cases of post-traumatic stress disorder (PTSD) to help patients process their traumatic experiences. The drug can create a safe and supportive space for individuals to explore difficult emotions and memories. MDMA has been found to reduce fear and facilitate communication, which can be particularly beneficial in therapy. The substance has also been effective in helping individuals overcome depression and feelings of hopelessness. However, it is essential to use MDMA in controlled therapeutic settings under the guidance of trained professionals to ensure safety and maximize its therapeutic benefits.
The criminalization of MDMA
Despite its potential therapeutic uses, MDMA faced criminalization efforts by the DEA in the 1980s. The DEA determined that MDMA should be classified as a Schedule I drug, alongside substances like heroin and LSD. However, this decision was challenged in court, with experts and therapists arguing for its medical value. The case showcased the benefits of MDMA, including its ability to reduce fear, promote empathy, and facilitate emotional processing. While MDMA can present certain risks, such as hyperthermia and potential emotional distress, when used in therapeutic settings, it has shown promise in treating mental health conditions like PTSD.
The integration of MDMA in therapy
The use of MDMA in therapy allows individuals to explore and process traumatic experiences in a supportive and controlled environment. Unlike classic psychedelics, MDMA does not cause ego-dissolution or hallucinations. Instead, it enhances empathy, communication, and emotional openness, making it easier for individuals to confront difficult memories and emotions. MDMA-assisted therapy has shown success in treating PTSD and depression, allowing individuals to gain new perspectives, heal emotional wounds, and build a more positive outlook on life. However, it is crucial to note that the therapeutic use of MDMA should only be conducted by trained professionals and in compliance with legal and ethical guidelines.
The Journey to Legitimacy: A 30-Year Quest for MDMA as a Therapy
Over the course of 30 years, the Multidisciplinary Association for Psychedelic Studies (MAPS) has been working tirelessly to legitimize MDMA as a therapy for Post-Traumatic Stress Disorder (PTSD). They have conducted Phase 2 pilot studies in multiple countries, exploring different patient populations and doses. After receiving Special Protocol Assessment and breakthrough therapy designation from the FDA, they are now preparing for Phase 3 studies, aiming for FDA approval by the end of 2021. MAPS has also established Expanded Access programs to provide compassionate use of MDMA to those suffering from PTSD before FDA approval.
The Therapeutic Potential of MDMA in a Clinical Setting
The therapeutic value of MDMA lies in the setting and intention in which it is used. Unlike recreational use, MDMA in a therapeutic context allows patients to turn inward, focusing on their emotions and experiences. The therapy provides a safe space to process difficult material, allowing individuals to welcome conflict rather than avoiding it. MDMA therapy is uniquely helpful in developing a different relationship with past traumas, helping patients in their journey towards healing and transformation.
The Regulatory Path and Breakthrough Therapy Designation
MAPS has navigated the regulatory process for FDA approval of MDMA-assisted therapy. They obtained Special Protocol Assessment and breakthrough therapy designation, signifying a promising treatment for a condition that lacks effective alternatives. MAPS has worked closely with the FDA to negotiate the study design and other requirements for Phase 3 trials. Beyond FDA approval, MAPS has also established Expanded Access programs to provide MDMA therapy to individuals with PTSD before formal approval.
LSD: Origins and Potential Uses
LSD, a synthesized molecule, was first discovered by Albert Hoffman in the 1940s. Initially developed to study postpartum bleeding, Hoffman later discovered its profound psychoactive effects. It was eventually used for therapeutic purposes, particularly in the treatment of alcoholism and addiction. LSD gained attention from the military, leading to research on mind control. Around the same time, psilocybin, the active ingredient in magic mushrooms, was also discovered. Timothy Leary, a renowned psychologist, became interested in psychedelics and conducted various studies, including the famous Good Friday Experiment at Harvard. The potential therapeutic effects and spiritual experiences associated with LSD and other psychedelics paved the way for further research and exploration.
The Future of Psychedelics
Over time, the perception of psychedelics shifted, with their spiritual and therapeutic potential becoming more prominent. Rick Doblin emphasizes the importance of refining their use in therapy and integrating psychedelics into mainstream practices. MDMA, in particular, shows promise in the treatment of PTSD, alcoholism, and other mental health conditions. With ongoing research, efforts are being made to establish licensed psychedelic clinics where individuals can access MDMA, ketamine, psilocybin, and other substances for therapy or personal growth. This vision aims to break cycles of trauma, foster healing and connection, and contribute to the evolution of humanity.
The Good Friday Experiment: Psilocybin and Mystical Experiences
The Good Friday experiment aimed to scientifically evaluate whether psychedelics could produce spiritual and mystical experiences. Divinity students were given psilocybin or placebo during a Good Friday service. A questionnaire was developed to evaluate the mystical experience, and the results showed that psilocybin had the potential to catalyze mystical experiences. Long-term follow-up revealed positive benefits and a connection between the experience and social justice activism. The experiment faced challenges with blinding and scientific misrepresentation.
The Concord Prison Experiment: Reducing Recidivism with Psilocybin
The Concord Prison experiment explored the potential of psilocybin to reduce recidivism among prisoners. The prisoners were given psilocybin or placebo, and the results were initially reported as successful in reducing reincarceration. However, a later follow-up study discovered flaws in the data and reporting. The data suggested that there was no significant difference in recidivism between the psilocybin and placebo groups. The experiment emphasized the importance of integrating the experience and providing aftercare, and called for a repeat of the study with proper controls and support.
In this episode, Rick Doblin, founder and executive director of MAPS, discusses MDMA, a molecule that has (at a minimum) revolutionary therapeutic benefits for PTSD, but arguably could have, at the highest order, a lasting impact on humanity’s ability to peacefully coexist. Rick details the history of MDMA, what lead to its unfortunate criminalization, and his lifelong work trying to protect MDMA (and other psychedelics) from criminalization (and his subsequent attempt to decriminalize it). Through his founding of MAPS, Rick has made enormous progress in debunking many of the exaggerated risks being claimed against MDMA (neurotoxicity, memory loss, depression, Parkinson’s, etc.), and is very close to getting FDA approval for a psychotherapy technique using MDMA. Additionally, in this discussion, you will learn about the history of LSD, psilocybin, and other psychedelics and how the combination of the misunderstanding of them with the crackdown on drug use in the 1970s lead to their designation of schedule 1 substances. But it’s important to note that you will also realize from this discussion just how different MDMA is compared to the average psychedelic. We end this discussion with a message of hope: there are going to be many people who are going to wonder what can they do to receive this MDMA therapy. We talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy (prior to its approval) they can have an understanding of the legal paths to doing just that.
We discuss:
Discovering MDMA, how Rick learned about it and his first experiences with it [9:45];
The timeline of MDMA’s evolution, the reinvention in the 1970s, “ecstasy”, the criminalization of MDMA [21:10];
Explaining the different “schedules” of drugs [30:55];
Rick’s fight to protect it for therapeutic uses, losing to the DEA despite winning in the court, the scientific community, and the media [38:25];
The risks involved with taking MDMA [42:30];
An incredible MDMA-LSD case study: Rick’s story of healing a treatment-resistant PTSD patient in the 1980s [44:45];
How and why MDMA was declared illegal on an emergency basis going against the judge’s recommendation after hearing Rick’s compelling case (and multiple appeals) in court [57:15];
Rick’s decision to study politics to affect change from the inside out, and the recent progress being made with the DEA [1:07:00];
Debunking the exaggerated risks of MDMA (e.g., neurotoxicity) [1:16:30];
Rick’s unbelievable ability to play the long game [1:28:45];
Which patients would not be good candidates for MDMA from a safety perspective? [1:34:30];
How MDMA is different from all other psychedelics, the importance of the setting, and Peter’s experiences with MDMA [1:36:30];
MDMA studies which lead to the crucial designation as a “breakthrough therapy” [1:40:30];
How someone with PTSD can get treated now through “expanded access for compassionate use” [1:46:00];
Rick’s ultimate goal and long term vision for psychedelic clinics [1:50:30];
Trip of Compassion documentary, and how psychedelics could change the world [1:52:30];
Rick’s early life: Resisting the draft, his feeling of wanting to change the world, and his profound experiences with LSD and other psychedelics [1:55:30];
The history of LSD and psilocybin, and the CIA’s interest in psychedelics [2:10:45];
Timothy Leary and the Good Friday Experiment [2:22:00];
Rick’s follow up study to the Good Friday Experiment, and his criticism (and praise) of Tim Leary [2:33:50];
Peter’s experience taking psilocybin [2:44:30];
The Concord Prison Experiment, and Rick’s follow up study 34 years later [2:47:00]; and
