I study psychedelics. The organization I work for – the Multidisciplinary Association for Psychedelic Studies (MAPS) – has been researching MDMA since 1992, seven years after the substance was prohibited. Our organization was founded in 1985.
One of a few treatments designated a breakthrough therapy by the FDA, MDMA-assisted therapy for post-traumatic stress disorder is an incredibly promising treatment for this devastating mental injury. Survivors of PTSD may struggle to stay connected in their work, families, and communities. They often live with symptoms like insomnia, hyper-vigilance and isolation; these commonly lead to substance use disorder, depression, chronic pain or heart problems. Yet most of the available treatments provide symptom relief for only about half of the people with the diagnosis, with even fewer people experiencing remission.
In May 2021, Nature Medicine published the results of the most advanced trial of psychedelic therapy to date. In our Phase 3 trial of MDMA-assisted therapy for PTSD, 88% of participants who received MDMA in conjunction with trauma-focused therapy experienced a clinically significant reduction in symptoms; 67% of participants no longer met criteria for a PTSD diagnosis. Many participants reported MDMA-assisted therapy helped them address the root cause of their trauma for the first time.
An exploratory study suggests a role for MDMA in couples therapy. MAPS has combined its MDMA-assisted therapy protocol with Cognitive Behavioral Conjoint Therapy (CBCT) for PTSD, in which both the person with PTSD and their partner are administered MDMA. Results demonstrated dramatic reductions in PTSD symptoms and partner accommodation, improving the quality of relationships for six couples.
Ketamine studies have shown promise for chronic suicidal tendencies, PTSD symptoms and depression. Legal ketamine clinics which pair therapy with the drug can play a key role in maximizing the benefits and reducing the risks of the psychedelic experience. Psilocybin-assisted therapy is a breakthrough therapy for depression. Ibogaine may be an effective treatment for opioid use disorder.
In fact, four separate systematic reviews have been published this year highlighting the potential of psychedelic-assisted therapies for those conditions and more: end of life care, brain injury, neurodegenerative disorders, mood disorders, smoking cessation and addiction or dependence. Dozens of studies make a compelling case for rapid expansion of research into psychedelic-assisted therapies for serious mental health conditions.
Evidence indicates that psychedelic use is associated with pro-social, personal growth benefits including increased nature relatedness, potentiating conflict resolution and sustaining compassion among first responders. Indigenous communities around the globe have used psychedelics in spiritual ceremony and healing for millennia.
Conversely, the well-documented devastation of the war on drugs has been responsible for untold trauma. But is the legalization and regulation of all substances – reversing the course on the war on drugs – too dangerous? Simply: No. It’s more dangerous not to.
Decades of research – and far more extensive use outside clinical settings – demonstrate that the risks of drugs, for most people, are generally short-term and manageable through compassionate risk-reduction measures. For those who become dependent on drugs, treatment-on-demand is a more effective intervention than criminalization. In lieu of a legal, safe supply of substances, drug checking can identify adulterants like fentanyl. Peer support is so successful in transforming emotionally challenging experiences that Denver’s first responders and police officers will soon be trained in the method as an alternative to criminalization or sedation.
Last year, Oregon became the first US state to decriminalize the possession of most drugs and to create a legal system for supervised psilocybin experiences. California, Vermont and Hawaii are actively considering new legal frameworks for psychedelics; Texas is directing state funding to research. In the face of an epidemic of veteran suicide, the US veterans administration is hosting small psychedelic-assisted therapy trials. Members of Congress from both sides of the aisle support federal funding. Lawmakers, regulators, funders, insurance providers and therapists who take a clear-eyed look at the research may be surprised to find their fears dissolving.
MAPS recognizes that the people who are most marginalized by society are often those who are most traumatized, have least access to a diagnosis and even less access to adequate treatment. MAPS is working with researchers around the world to facilitate studies of psychedelic-assisted therapy with refugees, transgender communities, first responders exhausted by Covid, people of color subjected to racial trauma and more. We envision a day when psychedelics will be more than a last-ditch treatment: they will be a catalyst for mass mental health.