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Background: Alcohol and other substance use disorders are commonly associated with post-traumatic stress disorder PTSD , and the presence of these comorbidities is associated with worse treatment outcomes. Additionally, disparities in substance and PTSD prevalence have been associated with minority races and ethnicities, and minorities have been shown to be less likely to engage in treatment. Psychedelic-assisted treatments, including 3,4-methylenedioxymethamphetamine MDMA , have shown preliminary trans-diagnostic effectiveness, however it is unknown how individuals with substance use disorders view the therapeutic potential of MDMA therapy. Previous studies have also shown that minority races and ethnicities are under-represented in the MDMA trials, leading to concerns about inequitable access to clinical treatment. Methods: To explore demographic characteristics related to patient-level perspectives on the therapeutic potential of MDMA-assisted therapy, this study describes data from a nationwide, cross-sectional survey of individuals self-reporting criteria consistent with alcohol or substance use disorders. No race or ethnicity differences were found in support for further research or belief in effectiveness, however there were small disparities in terms of willingness to try MDMA-assisted therapy and concerns related to use of this treatment approach. Conclusion: These results provide insights and future directions as the field of psychedelic-assisted therapy seeks to provide equitable access to clinical care and to diversify research participation. Substance use disorders including alcohol and tobacco are highly prevalent globally, and commonly occur in the context of other mental health disorders, including post-traumatic stress disorder PTSD. Substance use varies as a function of legalization status and cultural norms, and prevalence rates of PTSD vary as a function of population exposure to war, regional traumas, and intra-familial violence as well as cultural values and other influences. A reciprocal relationship between these comorbidities has been noted. Individuals with substance use disorders are more likely to experience traumatic events and to develop PTSD, and individuals with primary PTSD are more likely to develop substance use disorders hypothetically to self-medicate PTSD symptoms 1. Previous work has shown individuals with a substance use disorder are 6. Furthermore, individuals with these comorbid disorders are more likely to experience symptoms that are refractory to treatment 4—6. The prevalence of PTSD has been noted in some studies to vary as a function of race and ethnicity. Other studies of Vietnam Veterans found that individuals identifying as African American or Hispanic were found to be at higher risk of developing PTSD compared to individuals identifying as non-Hispanic White 8. A later study of individuals living nearby during the terrorist attack in New York City on September 11, also showed that Hispanic individuals were more likely to have symptoms of PTSD 9. More recently, lifetime prevalence of PTSD has been estimated to be 8. Additionally, an increasing body of research supports the development of PTSD symptoms in response to race-based trauma, previously defined as a cumulative traumatic effect of racism on an individual Notably, rates of both substance use disorder and PTSD treatment have been shown to be significantly lower in all minority race and ethnicities compared to individuals self-reporting as White Compared to White individuals, Blacks and Hispanics have been shown to have significantly lower substance use disorder treatment completion rates 13 , Additionally, previous work has shown that Black individuals undergoing treatment had worse outcomes compared to White individuals, while Latino individuals had improved treatment outcomes compared Whites and Blacks. Furthermore, among individuals seeking integrated treatment for comorbid substance use disorders and PTSD, studies of veterans have shown reduced rates of treatment response in African Americans compared to Whites Despite the high prevalence of these comorbidities, there are no pharmacologic treatments which have been shown to be effective in improving symptoms of both types of disorders. Within the United States, there are medications approved for alcohol use disorder disulfuram, naltrexone, and acamprosate and three medications approved for opioid use disorder treatment methadone, buprenorphine, and naltrexone. There are currently no approved pharmacotherapies for cocaine, amphetamine, cannabis, or benzodiazepine use disorders. Similarly, while multiple behavioral therapies for combined PTSD and substance use disorders have been explored i. Compounds with psychedelic properties have been explored for their trans-diagnostic effects in the treatment of mental health disorders. Psilocybin and ketamine are among the more well studied compounds with psychedelic effects, and both have shown preliminary effectiveness in multiple types of substance use disorders including alcohol and tobacco as well as other mental health disorders including major depressive disorder, PTSD, and anxiety-spectrum disorders 20— Further, 3,4-methylenedioxymethamphetamine MDMA , a compound with non-classical psychedelic effects received breakthrough therapy status designation from the United States Food and Drug Administration in , indicative of its potential therapeutic advantage over existing treatment options. In this Phase 3 study, subjects were permitted to have mild alcohol or cannabis use disorders, or moderate alcohol or cannabis use disorders if in early remission ; other substance use disorders were excluded. Other studies of MDMA-assisted therapy for the treatment of alcohol use disorder have shown preliminary effectiveness in reducing alcohol consumption Concerningly, demographic analyses of MDMA and other psychedelic-assisted therapy studies have shown that minority races and ethnicities are significantly underrepresented in psychedelic clinical trials. According to the United States Census, Overall, However, a systematic review of 18 previous psychedelic studies showed that only While sub-analyses have supported that psychedelics and MDMA-assisted therapy is equally safe and efficacious in these populations including in its ability to promote healing from racial trauma , other studies have suggested decreased interest or willingness to participate in psychedelic-assisted therapy 35 , Minority under-representation in clinical trials may occur from a variety of psychosocial concerns. Given the preliminary trans-diagnostic effects of MDMA and other psychedelics in previous trials, this study sought to explore patient-level opinions and beliefs on the research and clinical potential of psychedelic-assisted therapies among substance users. Level of support for further research into MDMA-assisted therapy was assessed, as well as beliefs about whether MDMA-assisted therapy might be a beneficial treatment. Additionally, the study assessed subject willingness to try MDMA-assisted therapy if it was deemed an appropriate treatment option for them and whether they had any concerns about trying the treatments. In addition to aggregate data about these patient-level perspectives, this study explored differences in opinions and beliefs as a function of race and ethnicity. In order to protect anonymity, written informed consent was not obtained. However, the pre-screening portion of the survey described the study and its purpose, and informed potential participants that submitting their responses constituted consent. Prior to completion of the main survey, potential participants were required to first complete a pre-screener questionnaire to verify inclusion criteria. Internet Protocol IP constraints were set up to prevent participants from taking the survey more than once. Recruitment was conducted through advertisements placed on the internet i. Both pre-screening and the main survey were conducted using the secure web database, REDCap. To be eligible for participation in the main survey, participants must have self-reported giving consent to participate in the study, being over the age of 18 and use of a substance of abuse at least once in the past month. Additionally, participants must have self-reported at least two of the following: 1 wanting to cut back on or stop a substance of abuse, 2 previously having been in treatment for alcohol or drug use, or 3 currently being in treatment for alcohol or drug use. Pre-screening questions are shown in Supplementary Figure 1. Potential participants were excluded if they 1 did not self-report at least 2 criteria for a substance use disorder, 2 did not report using a substance of abuse at least once per month, 3 denied ever wanting to cut back on or stop using a substance of abuse, or 4 did not give their consent to participate in the study. Initial screening eligibility using the inclusion and exclusion criteria was conducted using a pre-screener questionnaire hosted via REDCap. Participants were informed that participation in the study was voluntary, and they could discontinue at any time. Participants were provided with an overview of the study procedures in advance on the pre-screening questionnaire. Following completion of informed consent, and provided that all inclusion and exclusion criteria were satisfied, eligible participants proceeded to take the full survey. The survey was anonymous, but participants were asked basic questions about themselves such as their age, gender, race, and use of alcohol and various substances. These studies are one of the final steps before possible approval as a prescription drug. Improvements lasted more than a year after therapy. This gift card would be sent to their email address. If the participant did not wish to provide their email address, they could still take the survey, but they would not be able to receive compensation. Data was analyzed using the SPSS statistical software platform. Baseline demographic characteristics were collected from all participants and descriptive statistics for the sample population were analyzed. Descriptive statistics were analyzed with regard to overall sample with regard to regard to 1 level of support for further clinical trial research into MDMA assisted therapy, 2 subject belief that MDMA might be a beneficial treatment, and 3 subject willingness to try MDMA-assisted therapy. Additionally, Kruskal-Wallis H tests were used to evaluate potential differences between race and ethnicity group differences with regard to these three variables. Descriptive statistics were also analyzed with regard to proportion of the total sample expressing different potential concerns related to use of psychedelics. Of the individuals that initiated the survey, The demographic profile of respondents was generally diverse. Of the respondents that completed the full survey, a majority of individuals Survey respondents self-identified as being of one or more of the following race or ethnicity categories: American Indian or Alaska Native 4. A majority of individuals reported either supporting or strongly supporting medical research of MDMA Furthermore, a majority reported either strongly or very strongly believing that MDMA could be useful for the treatment of mental health disorders such as addiction and PTSD Similarly, if MDMA was proven to be a safe and effective treatment of a disorder that they suffered from, a majority stated that they would personally be willing to therapeutically use it Potential race and ethnicity group differences with regard to level of support for further clinical trial research into MDMA assisted therapy was assessed using a Kruskal-Wallis H test. Distributions of level of support were not similar for all groups, as assessed by visual inspection of a boxplot. Figure 1. Support vs opposition for medical trials with MDMA-assisted therapy in the future. Figure 2. Distributions of level of belief in benefit were not similar for all groups, as assessed by visual inspection of a boxplot. Finally, group differences with regard to subject willingness to try MDMA-assisted therapy were analyzed using a Kruskal-Wallis H test and are shown in Figure 3. Distributions of level of willingness to try MDMA-assisted therapy were not similar for all groups, as assessed by visual inspection of a boxplot. No other significant pairwise comparisons emerged. Despite overall high levels of support for MDMA research trials, belief that MDMA could be a beneficial treatment, and willingness to try the treatment if it was an appropriate treatment for their condition, a majority Concerns endorsed included fear of a bad trip Survey respondents were also queried about non-listed concerns, and 2. Of the 7 concerns that were submitted, 4 related to concerns about becoming addicted to a new substance, 1 expressed concern that they would say something they would regret, 1 was concerned about potential side effects, and 1 expressed concern that because they had previously done psychedelics, that they would not gain benefit from their therapeutic use. Survey respondents reported a mean number of 2. Total number of concerns by race and ethnicity is shown in Table 1. Only 4. A Kruskal-Wallis H test was subsequently conducted to determine if there were differences in the mean number of concerns reported between the racial and ethnicity groups. Values are mean ranks unless otherwise stated. Distributions of number of concerns were not similar for all groups, as assessed by visual inspection of a boxplot. Engagement in clinical treatments for PTSD and substance use disorders have been shown to be significantly lower in minority race and ethnicities compared to individuals self-reporting as White, and individuals with alcohol or substance use disorders are more likely to experience symptoms that are refractory to PTSD treatment. MDMA and other psychedelic-assisted therapies represent an exciting new trans-diagnostic treatment approach, however minority races and ethnicities have been significantly under-represented in previous research trials. These disparities in psychedelic research trials have further prompted concern that clinical adoption of these treatments may also be inequitable, although reasons behind the reduced research representation remain largely unstudied. Importantly, no previous studies have directly assessed patient-level perspectives on psychedelic-assisted therapies as a function of race and ethnicity. The results of this study indicate that an overall majority of individuals self-reporting criteria for substance use disorders including alcohol support continued clinical trial research of MDMA-assisted therapy, with no between-group differences in level of support found between the races and ethnicities. Similarly, an overall majority reported either strongly or very strongly believing that MDMA could be useful for the treatment of mental health disorders such as addiction and PTSD, and no between-group differences were found with regard to this belief. Most germane to clinical treatment adoption, a majority of individuals with substance use disorders reported that they would be willing to try MDMA-assisted therapy if it were determined to be an appropriate treatment for their condition. Pairwise comparisons reported small between group differences. Previous work has suggested that the disproportionate illicit use of MDMA among Asian Americans may relate to feelings of acculturation stress and a desire for social connectedness Willingness to try a treatment modality may be influenced by both cultural and individual perceptions about the potential risks and benefits of the treatment, as well as prior experience with MDMA, which was not assessed in this study. Interestingly, there were no between group differences regarding the belief that MDMA-assisted therapy could be a beneficial treatment in general, which suggests that reduced willingness to try this treatment might be related either to greater assessment of potential risks or reduced belief that it would be of personal benefit. Future research studies and clinical work should examine not only levels of race and ethnicity participation, but concerns related to potential risks or harms that might be addressable with specific education or outreach efforts. One of the strengths of this survey is the relatively large sample size unique survey completers which generally represented a diverse demographic profile. Compared to national averages taken from US Census Data, there were higher proportions of all minority races except Asian Americans 4. Several important study limitations are to be noted. First, participants self-selected to participate in this online survey, potentially introducing selection bias. Additionally, participants were only eligible for participation if they self-reported 2 criteria consistent with a substance use disorder including alcohol as per Supplementary Figure 1 , these questions are not validated for formal diagnostic assessment. Additionally, PTSD and other psychiatric symptomatology was not assessed. Given that there has been more limited research into MDMA-assisted therapy for substance use disorders compared to PTSD, this may have influenced subject perception of treatment efficacy or willingness to try MDMA-assisted therapy. Importantly, this study was not designed to assess the efficacy of MDMA-assisted therapy in the treatment of substance use disorders either singularly or co-occurring with PTSD , nor was this exploratory study designed to provide conclusive results about patient-level opinions on MDMA-assisted therapy. Additionally, this study demonstrated that a majority of individuals had some concerns about psychedelic-assisted therapies, which provide direction into further research, public education and counseling strategies related to these treatments. MDMA and other psychedelic-assisted therapies offer enormous promise in the treatment of refractory and comorbid mental health disorders. However, much work remains ahead. As MDMA and other psychedelics advance toward becoming clinical treatments, improving research diversity and ensuring equitable access to care are of paramount importance. The studies involving human participants were reviewed and approved by Institutional Review Board of the Medical University of South Carolina. JJ designed and implemented the study design, searched for the references, and drafted the manuscript including figures and tables. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is. Eur J Psychotraumatol. Am J Psychiatry. Trauma Surg Acute Care Open. Alcohol, cannabis, and other drug use: engagement and outcome in PTSD treatment. Psychol Addict Behav. Dealing with complexity and comorbidity: comorbid PTSD and substance use disorders. Curr Treat Options Psychiatry. The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context. J Traumat Stress. Trauma and the Vietnam war generation. Google Scholar. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. Posttraumatic stress disorder and symptoms among American Indians and Alaska natives: a review of the literature. Soc Psychiatry Psychiatr Epidemiol. Psychol Med. Posttraumatic stress disorder and racial trauma. Mennis, J, and Stahler, GJ. Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. J Subst Abus Treat. How long does it take to complete outpatient substance use disorder treatment? Disparities among blacks, Hispanics, and whites in the US. Addict Behav. Racial-ethnic disparities across substance use disorder treatment settings: sources of treatment insurance, socioeconomic correlates and clinical features. J Ethn Subst Abus. Drug Alcohol Depend. Ethnoracial differences in treatment-seeking veterans with substance use disorders and co-occurring PTSD: presenting characteristics and response to integrated exposure-based treatment. Pharmacological strategies for post-traumatic stress disorder PTSD : from animal to clinical studies. Posttraumatic stress disorder: overview of evidence-based assessment and treatment. J Clin Med. Efficacy, safety, and durability of repeated ketamine infusions for comorbid posttraumatic stress disorder and treatment-resistant depression. J Clin Psychiatry. Efficacy of ketamine in the treatment of substance use disorders: a systematic review. Front Psych. A single ketamine infusion combined with mindfulness-based behavioral modification to treat cocaine dependence: a randomized clinical trial. Am J Psychiatr. Adjunctive ketamine with relapse prevention—based psychological therapy in the treatment of alcohol use disorder. Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Nat Med. First study of safety and tolerability of 3, 4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder. Census Bureau Quick facts. Inclusion of people of color in psychedelic-assisted psychotherapy: a review of the literature. BMC Psychiatry. MDMA-assisted therapy for posttraumatic stress disorder: a pooled analysis of ethnoracial differences in efficacy and safety from two phase 2 open-label lead-in trials and a phase 3 randomized, blinded placebo-controlled trial. People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences. Drugs Educ Prev Policy. The psychedelic renaissance and the limitations of a white-dominant medical framework: a call for indigenous and ethnic minority inclusion. J Psychedelic Stud. A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific islanders. Am J Public Health. The need for psychedelic-assisted therapy in the black community and the burdens of its provision. Frontiers in Psychiatry. Chan, Michelle Stephanie Pomona Senior Theses, Psychiatry The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Jones, jonjen musc. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Psychiatry , 14 April Perspectives on the therapeutic potential of MDMA: A nation-wide exploratory survey among substance users. Jennifer L. Introduction Substance use disorders including alcohol and tobacco are highly prevalent globally, and commonly occur in the context of other mental health disorders, including post-traumatic stress disorder PTSD. Recruitment Recruitment was conducted through advertisements placed on the internet i. Inclusion criteria To be eligible for participation in the main survey, participants must have self-reported giving consent to participate in the study, being over the age of 18 and use of a substance of abuse at least once in the past month. Exclusion criteria Potential participants were excluded if they 1 did not self-report at least 2 criteria for a substance use disorder, 2 did not report using a substance of abuse at least once per month, 3 denied ever wanting to cut back on or stop using a substance of abuse, or 4 did not give their consent to participate in the study. Screening and informed consent Initial screening eligibility using the inclusion and exclusion criteria was conducted using a pre-screener questionnaire hosted via REDCap. Assessment procedures Following completion of informed consent, and provided that all inclusion and exclusion criteria were satisfied, eligible participants proceeded to take the full survey. Results Demographic profile of respondents Of the individuals that initiated the survey, Figure 3. Level of willingness to try MDMA-assisted therapy. Table 1. Total number of concerns by race and ethnicity. Reviewed by: Robert H.
Mechanisms of MDMA (Ecstasy)-Induced Oxidative Stress, Mitochondrial Dysfunction, and Organ Damage
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Coco loved being the life of the party — cracking jokes, doing pranks and making people laugh, her mom, Julianna Arnold, recalled recently. And they always looked fabulous on her. She never made it home. She was found dead the next day, two blocks from the address that the guy had provided her. Whatever the dealer gave Coco, her mother said, was not Percocet. It was a fake pill laced with fentanyl, which can be lethal in a dose as small as the tip of a pencil. Fentanyl overdoses have become a leading cause of death for minors in the last five years or so, even as overall drug use has dropped slightly. In a analysis of fentanyl-laced prescription pills, the DEA found that six out of 10 contained a potentially lethal dose of the drug. And social media, where tainted, fake prescription drugs can be obtained with just a few clicks, is a big part of the problem. The stories of these victims often play out similarly: The kids hear you can get pills on social media. A few taps later and then a package arrives. They retreat to the sanctity of their bedroom and take a pill. No one even knows until the next morning. Accidental overdoses in the U. DelPonte attributes this in part to more education and awareness about the issue. Among young people ages 0 to 19, there were 1, overdose deaths in , then 1, in , and 1, last year. A decade ago, people looking to buy illicit drugs online would visit the dark web. Using popular social media sites, encrypted chats, legitimate payment and shipping services, dealers moved into the light. Social platforms say they are constantly working to address the issue, while law enforcement has made some inroads. More than 1, associated cases involved social media apps and encrypted communications platforms, the DEA said. On Instagram, as recently as this summer, a simple hashtag search for popular prescription drugs brought up numerous results with accounts offering to sell illicit pills to anyone looking. Many accounts directed users to Snapchat or Telegram, where experts say encryption and alleged lax moderation make it even easier to engage in illegal activity. Money is sent through payment platforms and the drugs can be delivered by mail, DelPonte said. Meta, for its part, has made it more difficult to search for drugs on its platform in recent weeks. Mikayla Brown lost her son Elijah, who went by Eli, to a suspected fentanyl overdose in , two weeks after his 15th birthday. Eli loved skateboarding, video games and cooking. His favorite was spicy Cajun pasta his mom made and he just started to get into cooking himself. Eli began experimenting with marijuana in high school and he was going through what seemed like a phase many teenagers go through, his mom said. There was one exception, about a year before he passed away, his mom found him acting funny and he admitted to having taken Xanax, a prescription anti-anxiety drug. Eli was unresponsive. His cause of death was accidental fentanyl overdose. Meta also said it investigated accounts shared by The Associated Press and concluded they were not drug dealers, but financial scam artists based in Africa pretending to sell drugs locally. But drug dealers and other bad actors constantly shift their strategies, coming up with fresh ways to avoid detection. This is a challenge that spans across platforms, industries, and communities, and it requires all of us working together to address it. The company added that it works with law enforcement and proactively took down 2 million pieces of content, The teen was in therapy — social media really affected her and she developed anxiety and depression, Arnold said. We had talked about it. And there he was. Experts often single out Snapchat as a particularly dangerous platform, something the company vehemently disagrees with. In January, a judge ruled that the lawsuit could move to trial. Advocates are hoping that regulation of tech companies could help address the problem, as it might help with other dangers kids face on social media. In July, the Senate passed the Kids Online Safety Act, legislation designed to protect children from dangerous online content. It still awaits a vote in the House. Jeanne Shaheen, D-N. Roger Marshall, R-Kan. But for parents like Arnold, Brown and others who already lost their children to overdoses, it is too late. Support Provided By: Learn more. Monday, Oct The Latest. World Agents for Change. Health Long-Term Care. For Teachers Newshour Classroom. NewsHour Shop. About Feedback Funders Support Jobs. Close Menu. Yes Not now. Leave your feedback. Share on Facebook Share on Twitter. How social media became a storefront for deadly fake pills laced with fentanyl Nation Sep 12, PM EDT Coco loved being the life of the party — cracking jokes, doing pranks and making people laugh, her mom, Julianna Arnold, recalled recently. WATCH: Why Baltimore is seeing more drug overdose deaths than any other American city Fentanyl overdoses have become a leading cause of death for minors in the last five years or so, even as overall drug use has dropped slightly. A few taps away The stories of these victims often play out similarly: The kids hear you can get pills on social media. Regulatory remedies? Enter your email address Subscribe.
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