MDMA-Assisted Therapy paper

[trptamene]

I wrote this paper my freshmen year and changed a few peoples mind about the drug, so thought that it may be good to post it here and put out any new information that is not already there. (My name and the name of the professor have been deleted on purpose). The prompt was to choose a controversial topic and presents both sides of the story(part 1) and then to choose whichever side you agree with and argue for it (part 2).


As I said it was written a few years back, so some of the reference links may be out of date and some of the information may be obsolete. Please ask me via PM if you would like to use this in other places, I most likely won't mind, but I would like to know where it is being posted.

Here it is, feedback is appreciated:



English 1xxxx

22 November 2004

MDMA-Assisted Therapy

PART 1
Amanda, a waitress at an Italian restaurant in downtown Detroit, was scheduled to work on a beautiful summer day. She looked forward to getting off work because she had plans to go out with her friends later that night. Because she knew the risk of working downtown, she usually carried mace with her; unfortunately she had forgotten it on this particular day. After getting off work at midnight, Amanda headed toward her car, which because she worked downtown, was parked almost four blocks away. Unfortunately, she never made it. Amanda was brutally raped that night. Although it has been several years since the incident, Amanda still suffers from PTSD, post-traumatic stress disorder. Even though she endured extensive therapy and tried several medications on the market, she still has flashbacks, which bring back the enormous fear she felt that night. One day during a therapy session, the psychiatrist told Amanda about a controversial drug, commonly known as ecstasy. He explained to Amanda how users report feeling open to talk about particularly traumatic experiences while under the drugs influence. After talking with Amanda about it, she and her doctor both decided they had exhausted every other option, and while he would risk his license, the doctor decided that it would be worth it if the treatment did work. They proceeded with the ecstasy therapy session, and afterwards Amanda, felt she could openly talk about the rape and how dramatically it changed her life. No regression occurred, and it seemed that Amanda had been successfully, though illegally, treated for PTSD.

Although the above story is purely fictional, unfortunate factual variations of this story do exist. With only two prescriptions on the market for PTSD, few victims find relief (Doblin). Even though these two medicines are FDA approved for PTSD, they were initially marketed as antidepressants and are not very effective PTSD treatments (Doblin). Unfortunately, little is actually known about long-term affects of MDMA (3,4-methylenedioxymethamphetamine), the chemical name for ecstasy (Beck and Rosenbaum 9). Nonetheless, it has been shown to be an affective treatment for PTSD. The question that must now be asked is whether the pro’s outweigh the con’s. Thus, should MDMA be used in therapy?

MDMA was first synthesized by Merck Pharmaceuticals in Germany in 1912, and later patented in 1914. The first study of MDMA in literature was published in the early 1950’s by the Army’s Chemical Center. They were particularly interested in any toxicological properties associated with MDMA, most likely for military purposes (Rosenbaum). Around this time it was first used by therapists and researchers who recognized its potential medical properties. It was typically called “Adam” by these researchers, an obvious biblical reference. Prior to illegalization in the mid ‘80s, MDMA was made by only a handful of chemists who were more concerned with the contribution they were making to psychological health than with making money (Rosenbaum). It is estimated that roughly 500,000 doses were consumed during the early 70’s and 80’s, with drug abuse officials paying little attention (Rosenbaum). By 1983, MDMA was openly sold in nightclubs spanning the entire U.S. Its use began to rise dramatically after this, and it was only a matter of time before the government recognized its increasing use. It was placed as a schedule I drug in 1986 (Rosenbaum) Schedule I drugs are defined as having a high potential for abuse, and no current accepted medical use (“Amphetamines effects”).

Major obstacles for MDMA as a therapeutical tool began as recreational use started to increase. “The very properties that suggested MDMA might be therapeutically useful - its capacity to diminish anxiety and depression and promote easy emotional communication - may also create a danger of unconstructive use” (Grinspoon and Bakalar). In fact, it has been found that 1.5% (3.4 million) of Americans have tried MDMA during their lifetimes (“Drug Use”). Of concern to lawmakers are the hazards associated with MDMA use. “MDMA works in the brain by increasing the activity levels of at least three neurotransmitters: serotonin, dopamine, and norepinephrine. Much like the way amphetamines work, MDMA causes these neurotransmitters to be released from their storage sites in neurons resulting in increased brain activity” (Leshner). A very recent research paper entitled “Hallucinogenic Amphetamine Selectively Destroys Brain Serotonin Nerve Terminals: Neurochemical and Anatomical Evidence” shows that multiple doses of MDA destroy serotonin nerve terminals in the rat brain, and because MDA and MDMA cause the release of serotonin, it is likely that MDMA will produce similar neurotoxic effects (Boire). Serotonin plays an important role in sleep, mood, appetite, emotion and other behaviors (Leshner). By releasing large amounts of serotonin and inhibiting its synthesis, the brain becomes depleted of this vital neurotransmitter (Leshner).

In addition to potential neurotoxic affects, more immediate effects of the drug arise. These affects include, but are not limited to, increased heart rate, increased blood pressure, hyperthermia, a severe rise in body temperature. MDMA can also dehydration and even heart or kidney failure in particularly susceptible people (Leshner). Users also report mild to extreme jaw clenching, headaches, fatigue, and, though rarely, psychotic episodes, and panic attacks (“Amphetamine effects”). Exposure to MDMA can also pose great threat to pregnant women or women that may become pregnant. In May, 2001 the Journal of Neuroscience found that prenatal exposure to MDMA can cause memory loss and other major impairments to offspring (Leshner).

While there seems to be overwhelming evidence that MDMA poses a hazard to public health, it is important to keep in mind that many currently accepted medications can pose great threat to users. Adderall, a drug prescribed for attention-deficit disorder, can produce reactions including, but not limited to, increased heart rate, increased breathing rate, increased body temperature, and increased blood pressure (“Amphetamine effects”). There are also a number of antidepressant agents that, like MDMA, primarily affect serotonin levels in the brain (“Amphetamine effects”). As noted earlier, serotonin can play major roles in sleep mood and other behaviors (Leshner). There are also a number of anti-psychotic medicines currently prescribed that have dramatic effects on the brain and body (Saltz et al.). Effects can include drug-induced Parkinsonism, which is often indistinguishable from normal Parkinson’s disease - akathisia (overwhelming restlessness) and involuntary movements of the mouth, face and tongue (Saltz et al.). It is clear from this information that there are both advantages and drawbacks to many medications on the market.

Like these drugs already on the market, MDMA can have both positive and negative impacts. Despite its potential neurotoxic properties, MDMA has been shown to aid a number of ailments including PTSD, eating disorders, symptoms from Parkinson’s disease, chronic pain, and may help patients deal with cancer or other terminal illness (“MDMA Research”). Before being illegalized in 1986, MDMA was used as an adjunct to psychotherapy by psychiatrists and other therapists (Lewis). Trauma victims were treated with MDMA-assisted psychotherapy to help discover the source of their psychological problems. Most would experience healing, and in effect lead more productive lives (Rosenbaum and Doblin). Although in studies MDMA has been shown to produce adverse effects in the brain, it is important to note that subjects in such studies were given a dose many times more than the effective therapeutic dose. It has yet to be shown that, with doses at the same level as those traditionally used in therapy, there are any neurotoxic effects (Rosenbaum and Doblin).

There may be hope for MDMA advocates yet. During a teleconference in 1999, scientists were told they no longer had to conduct the stiff pre-clinical trials that had stood in the way of trials with humans for so long. Advocates were told they could conduct studies with cancer patients and finally have a scientific chance to prove the safety and effectiveness associated with medical MDMA use (Lewis). Although the study will not be allowed to begin until DEA approval, this is still a major milestone for those who believe MDMA may prove a valuable medical tool (“MDMA Research”). Furthermore, scientists in Spain began the first controlled study of MDMA-assisted therapy in 2000 (Lewis). The experiment is still ongoing, and final reports are likely several years off.

PART 2

As with almost every social controversy today, both sides of the argument have strengths and weaknesses. One of the major strengths of arguments made by those who do not favor the drug’s therapeutical use is the unhealthy side effects it may cause. As the body tries to maintain homeostasis, the drug puts stress on the body by altering its internal environment. As noted earlier, these side effects include changes in the body’s temperature and in the amount of water available for use (Leshner). Obviously this is not healthy for any individual; this fact greatly strengthens the argument of those who oppose its use in therapy, including the Drug Enforcement Agency. At the same time, there are also weaknesses to this argument. One of the most notable claims states that therapeutical MDMA use has neurotoxic effects. Although the drug has been shown to cause some neurological damage, the amount of MDMA needed to produce these effects is many times the therapeutical dose. Since many medications can cause adverse effects when taken in such great quantities, this is a weaker argument for those who oppose the use of MDMA in therapy.

There is yet another flaw in the argument proposed by the DEA and other opponents to MDMA therapy. Although it has been shown that MDA can destroy serotonin nerves in the rat brain, similar studies have not been conducted with MDMA. Without consideration the group jumps to the conclusion that MDMA must cause similar effects. With the treatment of thousands of patients hanging in the balance, it is irresponsible for government officials to jump to any conclusions in this matter.
The strongest argument for advocates of MDMA therapy is, more than likely, the fact that MDMA has been used effectively in therapy in hundreds of documented cases. Furthermore, the bulk of patients who receive MDMA treatment support its therapeutical use, and very few experience negative consequences from the treatment. A somewhat weaker argument for advocates is the claim that many medications, not just MDMA, have undesirable side effects. Although this is a valid claim, most medications have few side effects relative to those caused by MDMA use.

Although it is possible for me to see the concerns public officials have with therapeutical MDMA use, I believe the pro’s outweigh the con’s in this matter. I feel that it is severe injustice to deprive those with serious psychological disorders any potential treatment. There are individuals that will be forced to remain in institutions for the rest of their lives because attempts to treat these people with modern medicine fail. From reasons ranging from child abuse to sexual assault, others endure countless psychotherapy sessions in addition to vast medications. These medications are usually taken for long periods of time, lasting years, sometimes even until the patients’ death. Users of these medications report psychological side effects including depression, loss of motivation, and loss of humor (Saltz et al.). Although MDMA can also produce unwanted psychological effects, patients under MDMA treatment usually only endure two or three sessions. Because my grandmother spent the last ten years of her life in such an institute, I have emotional ties to this controversy. I was only five when she was admitted and never had much of a chance to spend time with her. I have been told by older family members that she would have been one of the nicest people I would have ever known. Although it is impossible to know for sure, I may have gotten to know my grandmother better had this treatment been available. I understand that there are individuals who are likely to disagree with my views on this subject. Ecstasy is probably one of the most used recreational drugs in the U.S., second only to alcohol, marijuana, and tobacco. Coming from an inner city high school, hardly a single day went by when I neither heard of students using ecstasy nor of discussing their plans on using the drug. I realized how abused the drug is when hearing of students insufflating, or snorting, the drug. I even remember hearing one student suggest using the drug intravenously. I understand that by allowing its use in therapy there is a greater chance for the drug to enter the black market and be used in ways that are unproductive for both the user and society.

Although drug users may take ecstasy for pure recreational use and in ways that may be detrimental to their health, it is not fair to deny treatment to numerous patients because of the irrational behavior of some people. Also, the drugs recreational use has actually increased since its illegalization in the ‘80’s; it is evident that drug users will continue to abuse MDMA despite its legal status. Therefore, it is my belief that MDMA therapy should be allowed in psychotherapy and similar medical treatment. Currently there are many documented cases of productive MDMA use in therapy, but because of government regulations only limited studies have been conducted in the matter. Consequently it cannot be confirmed that MDMA treatment will work in a large number of individuals. Until such studies are allowed and published, MDMA will likely remain in the same illegal category as heroin and other illicit dugs.





Works Cited
“Amphetamine Effects” Erowid. 15, Nov. 2004. < http://www.erowid.org/chemicals/amphetamines/amphetamines_effects.shtml>
Beck, Jerome., and Marsha Rosenbaum. Pursuit of Ecstasy the MDMA Experience. New
York: State University of New York Press, Albany, 1994
Boire, Richard Glen. “The Politics of Medicine: The Scheduling of MDMA.” Center for
Cognitive Library & Ethics. 2000. 13 Nov. 2004 <http://www.cognitiveliberty.org/dll/mdma_scheduling_history.htm>

Doblin, Rick. “Does Ecstasy Cause Memory Defecits?.” MAPS. 2001. 09 Nov. 2004 <http://www.maps.org/mdma/memintro.doc.>
“Drug Use: MDMA Ecstasy, Ecstasy Use Statistics.” NHSDA 1998. 13 Nov. 2004
< http://parentingteens.about.com/cs/ecstasy/l/blecstasy2.htm>
Leshner, Alan. “Hearing Before the Senate Subcommittee on Governmental Affairs - "Ecstasy Abuse and Control".” NIDA 2001. 15 Nov. 2004.
<http://www.drugabuse.gov/Testimony/7-30-01Testimony.html>
Lewis, Donald. “THERAPEUTIC MDMA (ECSTASY) & THE FEDERAL GOVERNMENT: A CLOUDY PAST & A HOPEFUL FUTURE.” MAPS. 2000. 13 Nov. 2004. <http://www.maps.org/mdma/LewisPaper.doc>

Grinspoon, Lester., and James Bakalar. “Can Drugs Be Used to Enhance the psychotherapeutic Process?.” AMERICAN JOURNAL OF PSYCHOTHERAPY,
Vol. XL, No. 3, July 1986. 13 Nov. 2001
< http://www.psychedelic-library.org/enhance.htm>

“MDMA Research Information.” MAPS. 16, Nov. 2004 <http://www.maps.org/mdma/#healing>

Rosenbaum, Marsha, and Rick Doblin. “Why MDMA Should Not Have Been Made
Illegal.” The Drug Legalization Debate. 1991. 16 Nov. 2004. <http://www.psychedelic-library.org/rosenbaum.htm>

Saltz, Bruce, Margaret Woerner, Delbert Robinson, and John Kane. “Side effects of
antipsychotic drugs, Avoiding and minimizing their impact in elderly patients”

Postgraduate Medicine 107 (Feb 2000). <http://www.postgradmed.com/issues/2000/02_00/saltz.htm>

Reputation Comments on this post:

	wonderful paper, disabusing misinformation on the subject is a wonderful cause, especially in school
	ace!

[Vinn`/]

Wow man, great paper it was a good read.

[trptamene]

glad you liked. Hope it wasn't too difficult to read? I'm having a little trouble getting the structure right, it doesn't want to save my indentations so that people can follow the flow of the paragraphs.

edit by trptamene: There maybe with the spacing it is a little easier on the eyes.

[Bajeda]

The latest MAPS bulletin (Spring/Summer 07) has a great article by Dr. Peter Oehen that describes in fairly extensive detail some of his thoughts on how MDMA can be used therapeutically, looking at both the neurobiological and the psychotherapeutic elements of MDMA assisted therapy for PTSD.

You can find it here. It starts on page 12.


Edit: And wow, the article on Ketamine is also very good. I didn't know that such prominent researchers of the drug actually died from their use of it because they didn't realize it had such addictive potential.

[tayo]

related paper I wrote...


"Psychedelic Research: Benefits Outweigh Downsides."
http://www.drugs-forum.com/forum/showthread.php?t=34875

[radiometer]

trptamene, if you haven't read these books, you really ought to check them out:

Ecstasy, the Complete Guide - Julie Hollands, ed.
The Secret Chief - Myron Stolaroff
The Healing Journey - Claudio Narranjo

All three books discuss extensively the topic of MDMA-assisted therapy (save Narranjo's, which deals instead with MDA and MMDA).

[trptamene]

Originally Posted by radiometer

trptamene, if you haven't read these books, you really ought to check them out:

Ecstasy, the Complete Guide - Julie Hollands, ed.
The Secret Chief - Myron Stolaroff
The Healing Journey - Claudio Narranjo

All three books discuss extensively the topic of MDMA-assisted therapy (save Narranjo's, which deals instead with MDA and MMDA).

sorry for l8 reply...been out of town for a bit...I have not read these, but they look interesting. Thanks for the info!
Too bad I didnt come across these when writing the paper.

[radiometer]

Of all of those books I believe you would find The Secret Chief the most interesting, and it is cheaply available in a current edition.

cheers,
R

[Bajeda]

Originally Posted by radiometer

and it is cheaply available in a current edition.

Yes, very cheap indeed

[tayo]

That guys a sex symbol!