Taking an inward journey: Part 3

MDMA: The next frontier in Psychedelic Integration Therapy.

— Kristófer Rabasca, created with the assistance of DALL·E 2

“I know so many people who think they can do it alone
They isolate their heads and stay in their safety zones
Now what can you tell them
And what can you say that won’t make them defensive
I know there’s an answer
I know now, but I have to find it by myself”
–From the Beach Boys’ “I Know There’s an Answer”

Well, as we wind down with the last of this “Inward journey” series (there were two before this one), it’s time to take stock and wonder what other modalities of “healing our noggins” are on the horizon. Thus far we’ve been feted to information about Psychedelic Integrative Therapy using ketamine, and the Internal Family Systems model of psychotherapy. We’ve also heard from a few Island folks who’ve been through that experience. Their honesty and forthrightness about why they sought out ketamine-assisted therapy, as well as their respective experiences during the six-session protocol, has given us a very substantive snapshot of what looking beyond the tried and somewhat true path of traditional psychopharmaceuticals can look like.

Since I was in psychedelic mode, I decided to reach out to MAPS — the California-based Multidisciplinary Association for Psychedelic Studies, a nonprofit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana (that’s a mouthful, isn’t it?)

MAPS’ mission statement is to envision a world where psychedelics and marijuana are safely and legally available for beneficial uses, and where research is governed by rigorous scientific evaluation of their risks and benefits.

Now, I didn’t know exactly what to expect. I mean, we all have our preconceived notions of what folks working in the field of psychedelics might be like. A little too “incense and peppermints,” perhaps? Not at all.

MAPS’ director of communications and marketing, Betty Aldworth, was the embodiment of professionalism. It’s obviously very well understood in the MAPS organization that in order to have folks listen to your message with an open mind, you just can’t come across like Timothy Leary (as equitable as his argument for psychedelic use was), or some holdover from Woodstock.

Aldworth proceeded to give me the origins of MAPS, which happens to coincide with a well-known psychedelic (hopefully) being approved by the FDA in the coming months.

“In 1985, MDMA [ecstasy] was being used by therapists legally — it wasn’t yet prohibited. It was being used In therapy sessions as well as socially (nightclubs, dance parties, etc). The DEA caught wind of the fact that MDMA was being used as a party drug and initiated a ‘scheduling hearing.’ Even back in 1985 to 1986, the scientific evidence did not support putting MDMA in Schedule I. This was very distressing to the community of therapists who were using MDMA in therapeutic settings (MDMA-assisted therapy). Rick Doblin, the founder and president of MAPS, was very much connected with that community, and saw the loss to therapy placing MDMA in Schedule I would be. He fought very hard against the scheduling of MDMA. But despite the evidence, the DEA placed MDMA in Schedule I in 1985, joining other psychedelics in Schedule I — heroin, peyote, LSD, marijuana, and methaqualone. Any drug, substance, or chemical placed in Schedule I classifies it (again, according to the DEA) as having ‘no accepted medical use and a high potential for abuse,’ which, as studies over the past almost 40 years have demonstrated, just isn’t the case when it comes to more than half the suspects in Schedule I.”

MAPS was formed in 1986 in response to this very arbitrary scheduling of MDMA in order to create a pathway to study psychedelics, to create the conditions to study psychedelics in clinical trials, and, ultimately, provide the body of evidence to overturn the scheduling.

“At this point it’s important to remember that LSD, psilocybin, and MDMA have all been used in therapeutic settings. Even the U.S. government used these substances in “studies” of its own, albeit in far less admirable circumstances.”

What Aldworth is referring to here is Project MKUltra (preceded by two other drug-related experiments, Project Bluebird and Project Artichoke). In case you’re not privy, these were illegal human experimentation programs undertaken by the CIA, intended to develop procedures for, as well as identify, drugs it could weaponize, that could be used in interrogations to weaken individuals and force confessions through psychological torture and brainwashing. MKUltra ran from 1953 through 1973. During that time, numerous methods were employed to manipulate the mental states and brain functions of its subjects without their consent: extremely high doses of LSD-25 and other chemicals, hypnosis, isolation, electroshocks, sensory deprivation, verbal and sexual abuse, and other forms of torture.

That bit of U.S. governmental history is necessary for context. Any drug can be abused or used for, as Aldworth referred to it, “far less admirable circumstances.”

So the scheduling of these substances, and in particular MDMA, clearly wasn’t based on the evidence. It was based on backlash, stigma, and media spin. It’s taken decades to try to redefine these substances — to destigmatize them — so that their inherent benefits could be recognized without bias.

Aldworth also broached an element to the whole prohibition mindset that needed emphasizing:

“You can’t criminalize being a hippie, and you can’t criminalize being Black. So the Nixon administration found a way to criminalize people based on their activities. All that ended up doing was halting all research into these substances and what they could do to benefit the public. In so doing, this propagated a great deal of trauma, sickness, depression, anxiety, and other mental illnesses. Much like with cannabis, if we had been studying MDMA for the 38 years it’s been illegal, for the 50-plus years that LSD and psilocybin have also been on Schedule I, we would be so much more advanced in our understanding of them. We would be treating these conditions with these very promising substances, and that is supported by the evidence we’ve seen thus far out of clinical trials.”

Aldworth continued, “When we stigmatize a substance, we stigmatize the person using that substance. People ought not be stigmatized for the choices they make about what they are going to put into their bodies. We’re all humans deserving of human rights.”

The other pachyderm in the room here is the fact that psychedelics just aren’t a great fit for pharmaceuticals (as we know them now). All psychedelic-assisted therapies are a limited number of sessions, with substances that are quite inexpensive to produce, and which have limited profit margins. Aldworth added, “It’s not a drug you take twice a day, every day, that you’re on for the rest of your life. That limits its appeal to a pharmaceutical system that is built on ‘take one in the morning, take one at night, for the rest of your life.”

MAPS has funded the MDMA Research Program almost entirely through philanthropy. It’s based on the generosity of thousands and thousands of individuals and foundations who have understood the MAPS mission and strategy, and decided it was worthy of a philanthropic investment. Thus far, MAPS has raised almost $140 million over the past 38 years in order to push this program forward. While that sounds like a lot of money, the vast majority of that money has gone toward a drug development program. “If you think about the costs that pharma invests to bring a drug to market, $140 million is very little,” Aldworth said.

“Through our nonprofit, philanthropic, and public benefit approach, we’ve been able to accomplish something quite extraordinary. Though we are reaching the end of the drug development program and submitting a new drug application to the FDA for MDMA-assisted therapy for PTSD later on this year, the work of MAPS must continue.”

MAPS assesses that MDMA-assisted therapy for PTSD will be available by prescription with qualified behavioral health professionals sometime in 2024 to people outside of clinical settings.

If you’re wondering what a typical typical MDMA integrative therapy session would look like, here’s the protocol:

For eight hours, two behavioral health professionals must be present — one who is a therapist, and another who is qualified and certified to provide the actual MDMA therapy.

“It is really important for people to do an individual assessment of risks and benefits to educate themselves about the experience they are walking into — whether or not it is in a therapeutic setting or a social setting. Because these substances are not without risk,” adds Aldworth.

Back in 1986 when MAPS was founded, Doblin laid out a program for MDMA clinical research and eventual FDA evaluation. But that playbook has been followed by virtually every researcher of a psychedelic-assisted therapy ever since. And it’s not just about getting MDMA approved. It’s important that the public understands the fundamentals of psychedelics, and is well-educated about their possible uses and possible risks.

“The way I like to look at it is like this: Half the time, the pharmaceuticals most commonly described for PTSD don’t work. But for the other half they do,” Aldworth says. “We have to recognize that whatever is going to help a person, don’t mess with that particular approach — if it’s not broken, don’t try to fix it. But if a person isn’t seeing any discernible results, why shouldn’t they have the option to try something else?”

Then there’s symptom constellations, which are groups of symptoms that are understood to go together, to be “participants in the same illness,” and which, when traveling together, allow us to call an illness by a name. If you’re one who struggles with a mental illness, like I do — bipolar depression (supposedly), damned glad to meet ya — then you’re all too familiar with the dartboard-like process of diagnosis you have to endure, not to mention the parade of different psychotropic drugs you’re prescribed. Not a good time.

Aldworth chimes in, “Symptom constellations can be so incredibly similar that it can be difficult for a clinician to differentiate. That being the case, it makes it hard for an actual diagnosis to be made: You’re bipolar … no, you’re ADHD. Oh, wait … you have PTSD. It can be incredibly frustrating.”

The other thing folks need to be made aware of is good manufacturing practices (GMP) — the quality and purity of the product of a known potency (psilocybin, marijuana, MDMA). “If we do our job right, and are able to get these drugs FDA-approved, then we can appeal to the insurance companies to provide coverage for the treatments,” declares Aldworth.

When asked if there was any way someone can become involved in advancing the mission of MAPS — of educating the public about the good that psychedelics can do — Aldworth was quick to answer: “Absolutely! We certainly have traditional volunteer opportunities at MAPS. We have Psychedelic Science 2023 coming up in June, between the 19th and 23rd, in Denver. It’s expected to be the largest formal gathering of psychedelic experts and enthusiasts in history. It’s going to include tracks on history, culture, science, even business.”

Sometime in 2024 you will be able to speak with your therapist about it, and they will be able to help you find a practitioner (provided they feel it’s a good option for you — it’s not for everyone).



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