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Episode 2: Will Doctors Soon Prescribe Ecstasy?

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The U. Food and Drug Administration is poised to decide whether to approve MDMA-assisted therapy for the treatment of post traumatic stress disorder. Psychedelics are now at the center of a global conversation about mental health, mysticism, and even how we experience illness and death. Listen to more episodes here. ADR: If you were to characterize the current moment that we are in, where we have these phase 3 trials of MDMA, how would you summarize this moment historically? ADR: So was there a point in time when psychedelics was actually part of the medical establishment? MP: LSD was considered a miracle drug in psychiatry, and there were like six international conferences devoted to LSD between and , something like 40, research subjects. MP: When the Controlled Substances Act was passed in and signed by President Nixon, it did not ban research in psychedelics, but it made it very difficult to do. MP: Around the turn of the millennium is when the so-called psychedelic renaissance begins. MP: It also leads to a release of oxytocin, which is the bonding hormone released between mothers and nursing children, released during sex. ADR: And unlike most of what we think of as the classic psychedelics, like LSD, psilocybin, and mescaline, which were all originally derived from organic plants and fungi, MDMA is completely synthetic. MP: It was synthesized by a pharmaceutical company, Merck, and they never used it for anything. MP: And one of his graduate students had called his attention to this interesting looking compound called MDMA, and it was out of patent by then. MP: And he also shared it with his wife Anne, who was a therapist in the Bay Area and very connected to other therapists in the area. MP: And she suggests after her own experience with it, that this is a really ideal substance to use in the talk therapy room, that it would free people to talk about difficult issues without feeling defensive or antagonistic, and create an almost instant bond with their therapists. MP: And that really happens when some very enterprising drug dealer decides to call it ecstasy. MP: Over the objection of many people, especially therapists, who felt it was a valuable drug that they were losing. MP: The Drug Enforcement Administration wants it to control like heroin, a drug considered to have no medical use. MP: Well, if you go back to the origin of the term psychedelic, basically what psychedelic means is mind manifesting. MP: And that term, which we think of as a 60s term, you know, the psychedelic 60s, is actually a 50s term. MP: So Osmond tries it with his collaborator, and they realize, hey, this is nothing like schizophrenia. MP: They go back and forth, and interestingly enough, it is the psychiatrist, not the writer, who comes up with the winning name, psychedelic. ADR: What do you make of the fact that people might say that the use of that word psychedelics was a re-branding of some mind-altering plants that had been in use by indigenous people for a very long time? MP: They had learned that they were very powerful and had to be used in a very intentional way, that you had to create a kind of ritual container, and that you use them in a social context with a lot of attention to set and setting. MP: Set is the mindset, the attitude you approach the experience with, and the setting is literally the environment in which you are in. MP: Compare that to people putting LSD in the punch bowl in parties in the 60s or acid tests in the 60s. MP: I mean, that was a really reckless way to use these substances and had people had sufficient respect for indigenous cultures and practices, they would have known that was a bad idea. MP: Initially, in the research context, when they were testing LSD, they would put you in a fluorescent-lit clinical room, painted white or, you know, nauseous green, give you LSD, and then leave the room. MP: So Rick Doblin is a guy who aspired when he was in college to become a psychedelic therapist. MP: He then sets his mind to undoing that, what he regarded as a disastrous decision, not just for him, but for the culture, and that he was going to start an organization called the Multidisciplinary Association of Psychedelic Studies or MAPS that had as its goal the return of MDMA to legality as a therapeutic agent. MP: But he stuck to it, and remarkably enough, he plotted a path that would bring MDMA back to approval as a medicine. MP: Timothy Leary being the psychologist who started the Harvard psilocybin project and went off the rails as a scientist. MP: Gently but became a very important figure in the 60s counterculture with his turn on, tune in, drop out. ARCHIVAL 7: And I think if we can really globalize access to psychedelic healing, destigmatize it and globalize this post-prohibition world, by , we should have a net zero trauma world. MP: MAPS is an organization that takes grants from all different kinds of philanthropists and has members. MP: What a pharmaceutical company might do, and probably will do, should MDMA become accepted, is tweak the molecule in some ways. MP: Only the fact that it has patent protection, and with patent protection, you can go out and raise a lot of money. MP: You have to realize too that the model of a successful pharmaceutical is a pill you take every day for the rest of your life. MP: The reason for that is that to deal with the set and setting issues that we were talking about earlier, you need a lot of therapeutic support. MP: You sit with them the entire time, and then after the experience, you have an integration session, which lasts several hours. ADR: That process involved designing and executing a bunch of different studies and finding people who were willing to participate in these experiments. ADR: Michael, in general, what are some of the factors that make studying how people respond to psychedelics different from other drugs? MP: So you can optimize the chances of having a positive experience by manipulating the set and setting, and making it very safe and warm, and you can prime it too for people to have a somewhat spiritual experience by the kinds of objects in the room. MP: So it introduces this whole set of what are called extra-pharmacological factors into the experience and the research. MP: Blinding is very important to modern drug trials because you want to know for sure that the effect your drug is having is a result of the pharmacological action, not some expectation on the part of the clinician administering it, or on the part of the patient. MP: One receives the drug and the other gets a placebo, and you want to see the difference in the response to it. MP: So, they can just say, when this drug is prescribed, these regulations to mitigate risk must be implemented. MP: People talking about, you know, they could take their MDMA and then they might use cocaine and all these other drugs. MP: That if you really press people, a lot of these researchers believe that this is not just a medicine. MP: Or rather, this is a medicine not just for individuals, but a medicine for our culture. MP: So there was a real split, and people in power saw no reason to support these drugs and crack down on them. MP: Former heads of the American Psychiatric Association have spoken about their use of psychedelics. MP: Their power is that they are disruptive, and societies tend to frown on things that are disruptive. MP: So, I think you have to weigh the potential to heal, which I think is very real, and not just for MDMA, against the challenges these drugs can produce in a culture. ADR: At the same time, we have this other really prominent and very different psychedelic experiment going on in Oregon, where I live. ADR: Here, people are now able to access psilocybin legally, and the framework is very explicitly not medical, right? MP: Unless this becomes a flaming disaster in Oregon, which is not out of the question, I think the feds are just going to watch, sit back and watch and see what we can learn. MP: In the same way that massachusetts is watching Oregon and Colorado is watching Oregon, and it just becomes a fairly safe way to test a pretty radical idea. ADR: The outcome of that decision could have significant ripple effects for psychedelic science on everything from funding and public perception to the likelihood of future drug approvals. ADR: Most well-known psychedelics remain illegal around the world, including the United States, where it is a criminal offense to manufacture, possess, dispense or supply most psychedelics, with few exceptions. ADR: Altered States does not recommend or encourage the use of psychedelics, or offer instructions in their use. Skip to content. ADR: That recommendation cast out onto a process that has been decades in the making. ADR: And any day now, the agency will issue its final decision. ADR: Michael, welcome to the show. MP: Good to be here. ADR: When was that? MP: But then it runs into the buzz saw of the 60s. MP: And by the mids all research had pretty much stopped. ADR: Okay, so how does that actually start? ADR: What changed? MP: Exactly. MP: But it acts very differently on the mind and on the body. MP: It muffles the amygdala, which is the fear center of the brain. ADR: Right. MP: Yeah. MP: They put it on the shelf. MP: And there it sat, under-patent and described in the patent literature. MP: And he synthesized it and tried it. MP: And it catches on. MP: This is pre MP: Then soon after that, it was picked up by the culture at large. MP: Brilliant marketing. MP: And so the drug is taken up by the culture here in England. MP: It fits really well or maybe helps inspire the rave culture. MP: So you can see already it has a different history than the classical psychedelics. MP: By one estimate, a million doses of ecstasy have been used. MP: Psilocybin as well, mescaline. MP: We just went underground. ADR: I do want to go back to this term psychedelics though. ADR: How is it that all of these substances with different origins got lumped together? ADR: What do they have in common? MP: T hese are all substances that make the subconscious more available. MP: And that book had a huge influence. MP: At the time, nobody knew what to call these drugs. MP: They were sometimes called, and originally called, psychomimetics. MP: And that meant they mimicked psychosis. MP: because outwardly, it seemed that way. MP: People seemed like they were having a psychotic episode. MP: They might feel depersonalized. MP: They were hallucinating. MP: It looked like schizophrenia to doctors who had the experience. MP: This feels really good. MP: And they decide that they had gotten it wrong, and it was something else going on. MP: It still has lots of baggage without question because of the 60s and the backlash. MP: And come back an hour later. MP: And people had bad experiences. MP: And it took a while to learn the importance of the container or the setting. MP: So there was a lot of trial and error figuring out how best to use them. MP: And had I known him at the time, I would have said he was crazy. MP: Right. MP: Left the psychology game for the guru game eventually. MP: Like Leary, you never see him not smiling. MP: Normally, this is done by pharmaceutical companies or universities. MP: And they advocate for decriminalization. MP: So they have a political agenda. MP: We saw that with ketamine. MP: They tweaked ketamine and offered a new way to administer it with a nasal spray. MP: Does it offer any advantages? MP: No. MP: You do not just give someone a pill. MP: You prepare them, which can take several hours. MP: Yet, you have to charge enough for the whole package. MP: No one has figured out the business model here still. ADR: So, it had to be an organization whose goal went beyond making money. ADR: That was legitimately the goal was to get this, you know, substance approved. MP: This was the legitimate work of a non-profit. ADR: Stay with us. ADR: Typical markers. ADR: That complicates things. MP: Yeah, it really does complicate things. MP: Psychedelics are a round peg in a square hole. MP: And they will be going forward. MP: So typically, you have two groups of people. MP: This is very hard to do in the case of psychoactive drugs. MP: Not completely. MP: They thought they were tripping, but it was really just the placebo. MP: Some people administering the drugs have also been fooled. MP: And people are often very disappointed when they get the placebo. MP: And they can require things, but how do they enforce them? MP: This is hard to do. MP: Let us not forget. MP: So it was a driving force. MP: And it is throughout psychedelic therapy, by the way. MP: I mean, this is a theme that, in my reporting, keeps coming up. MP: Really? MP: Yeah, so this goes back a couple of years. MP: He might feel differently after what happened in June. MP: They tended to be very young. MP: So all the oldsters in the culture saw kids using these drugs, and were freaked out by it. MP: The kids were acting weird. MP: It was clearly fueling this counterculture. MP: Whereas now, people in power have used psychedelics. MP: People all over government have used psychedelics. MP: I think it could still happen. MP: I think we saw some evidence that it might happen. MP: These are still frightening substances, disruptive substances. ADR: Okay. MP: They do reflect on one another in interesting ways. MP: I mean, Oregon is another path toward acceptance. MP: Absolutely. MP: Will there be a backlash? MP: Will this become a normal part of life? ADR: Be sure to tune in next week. ADR: Adiza Egan is our senior editor. ADR: Jenny Cataldo is our senior producer. From PRX. Share this page: Twitter LinkedIn Facebook.

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