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'The Business of Drugs': How MDMA-assisted therapy could be the key to helping trauma patients

Because MDMA places the brain in a 'more neuro-plastic state', the drug allows the patient's mind to shift and process underlying trauma

In Netflix's docuseries 'The Business of Drugs', former CIA agent Amaryllis Fox takes us through the economic background of six different controlled substances. The second episode on synthetics places a focus on MDMA, also known as Ecstasy, which was initially developed by a German pharmaceutical company in 1912. Originally known as “Methylsafrylaminc", it was intended as a parent compound to synthesize medications that control bleeding and not to control appetite as is often incorrectly cited.

The credit for introducing the drug to psychologists in the late 1970s for psychopharmaceutical use goes to American chemist Alexander Shulgin. He experimented in his makeshift laboratory and created more than 200 psychoactive compounds in his home laboratory, tested them all on himself and his wife and then wrote about them in a 1991 book titled 'Phenethylamines I Have Known and Loved' (PHIKAL).

An interesting aspect of the episode on synthetics in 'The Business of Drugs' is the use of MDMA in the treatment of PTSD. To that end, Fox talks to a veteran who spoke about his issues with post-traumatic stress disorder (PTSD) after his time as a soldier. When the veteran attempted suicide, a hospital intern passed him a note which he was asked to only open at home. The note said, "MDMA for PTSD," and was the beginning of how the veteran sought MDMA-based therapy with the Multidisciplinary Association for Psychedelic Studies (MAPS), which has research facilities in the US, Canada and Israel. With MAPS, the veteran completed three sessions of therapy and spoke about getting a renewed vigor for life and being motivated again.

MAPS completed Phase 2 clinical trials on the efficacy of MDMA combined with therapy as a treatment for PTSD, and Phase 3 trials – the final step before receiving the FDA's approval – are underway. Earlier this year, MAPS was granted an application for an Expanded Access Program for MDMA-assisted psychotherapy for PTSD by the agency. 

Though costs for MDMA drug development are high — an estimated $34M before FDA approval and $11M related to European Medicines Agency approval — MAPS is refusing investments from pharmaceutical companies in an effort to avoid competing interests.

Why does MDMA-assisted therapy work?

Because MDMA places the brain in a "more neuro-plastic state" according to MAPS, rather than masking or subduing symptoms as most prescription antidepressants do, the drug allows the patient's mind to shift and process underlying trauma. The chemical process involved in MDMA therapy varies. While it "squeezes" previously existing serotonin from the brain, it also causes the release of dopamine, oxytocin and norepinephrine. This cocktail of effects makes the drug potently useful for PTSD sufferers and does not tend to produce visual or auditory hallucinations.

In their Phase 2 trials, MAPS researchers found that MDMA can reduce fear and defensiveness, enhance communication and introspection and increase empathy and compassion. With these combined neurological effects, the therapeutic process for people suffering from PTSD is enhanced. 

According to a recent paper published by MAPS researchers in the journal Psychopharmacology, Phase 2 "treatment was safe and efficacious for civilians and veterans/first responders with chronic PTSD who had previously failed to respond to pharmacotherapies and/or psychotherapy". These findings suggest "a different mechanism of action for MDMA for reducing PTSD symptoms".

All episodes of 'The Business of Drugs' are now streaming on Netflix.