
How MDMA Went from Club Drug to ‘Breakthrough Therapy’ - anythingnonidin
https://www.wsj.com/articles/how-mdma-went-from-club-drug-to-breakthrough-therapy-1508332237
======
Synaesthesia
Funny because it started as a breakthrough therapy drug which Shulgin and a
few psychiatrists and escaped to become a club drug, especially in Texas. This
lead to it being placed in schedule 1 by the DEA, against recommendations by
doctors and scientists, that it should be allowed to be researched. The DEA
did this by passing a special law giving them emergency powers.

[http://www.maps.org/research-archive/dea-mdma/](http://www.maps.org/research-
archive/dea-mdma/)

Having had experience with MDMA I can attest to it’s near magical therapeutic
powers. But no drug is a panacea and it can certainly have drastic side
effects, particularly when abused but even if not.

~~~
lottin
It can be a nice experience, but I wouldn't call it therapeutic. I mean, it
won't change your personality or anything like that.

~~~
ada1981
False. When used in the right set & setting MDMA can have profound impacts on
people's lives.

The book Trust Surrender Receive has 40+ accounts of people use did
underground therapy with amazing results.

[http://bit.ly/mdmabook](http://bit.ly/mdmabook)

~~~
ada1981
Update: author website: [http://AnneOther.com](http://AnneOther.com)

------
AElsinore77
If you are unable to observe a thing directly, and instead could only see it
through a distortion lens, would you want the opportunity to look at it
through multiple different distortion lenses instead of just one?

The world we know is largely constructed by semi-conscious and sub-conscious
processes, from world building processes (such as how the mind filters and
modifies information to construct our reality), to conclusions we make about
the world, ourselves, and what is possible (emotionally motivated reasoning,
decision heuristics, predictive modeling).

Google deep dream provides interesting insight into psychedelic phenomena, and
hints at what is changing in the mind’s world-building process when on those
substances.

When it comes to MDMA, because it so dramatically changes emotion, it can also
dramatically shift reasoning and thinking heuristics that unconsciously
originate from emotion. This can transform beliefs that you once took for
self-evident fact, into things that you now realize represent how you feel
more than reality.

Some further reading that I found very valuable: World Building Process:
[https://www.ted.com/talks/anil_seth_how_your_brain_hallucina...](https://www.ted.com/talks/anil_seth_how_your_brain_hallucinates_your_conscious_reality)
Deep Dream:
[http://www.slate.com/articles/technology/bitwise/2015/07/goo...](http://www.slate.com/articles/technology/bitwise/2015/07/google_deepdream_it_s_dazzling_creepy_and_tells_us_a_lot_about_the_future.html)

------
anythingnonidin
It is absolutely shocking to me that research into MDMA and classic
psychedelics isn't swamped with funding. I'd imagine that some wealthy people
must find this stuff extremely intriguing - Yuri Milner is spending $100
million on space exploration, and an MDMA phase 3 research trial needs ~$15
million and finds it really hard to raise money?

Both have extremely high therapeutic potential, classic psychedelics in
particular are interesting in the same way that space exploration is
interesting.

And as diogenescynic noted elsewhere, it's even more shocking that we as a
society put up with it.

~~~
westoncb
Maybe it's due to fear of social stigma? Something like, "Yuri Milner spends
$100 million on psychedelic drug research" —could be reputation changing.

~~~
soundwave106
I think that might have been true a couple of decades ago, but I'm not sure if
it's the case today.

A good recent example is ketamine. The drug, or, rather, the mechanism behind
it, has gotten a large push research wise of late, since it was discovered
that ketamine relieved depression using a mechanism that current anti-
depressants do not utilize. Until further drugs are developed, "ketamine
clinics" for off-label treatment-resistant depression also exist. And there
really doesn't seem to be a huge issue made about them.

I would hazard a guess (unfortunately) that one of the barriers here regarding
fundraising among more commercial interests is the lack of the ability to
patent, which means that the rewards for making MDMA as a treatment are not as
great, as far as commercial backers would be concerned. In the case of
ketamine, drug companies are trying to develop chemicals that use the same
mechanism, but do not have the hallucinogenic side effects (an example
currently in Phase III would be Rapastinel). These efforts are able to get
corporate funding. Also, MAPS is more "advocacy group" than "medical
industry", not that there is a problem with that, but they might be outside
the circle of what the typical drug trial fundraising process goes through.

If MDMA even remotely has a chance (the fact that it passed Phase II trials
suggests this is the case), I definitely think it would be worth exploring, as
current medication options for PTSD seem to largely be limited to anti-
depressants (SSRI etc.). Ala ketamine, this would be a new approach.

~~~
kortex
There's still many opportunities to patent, they just aren't as "easy" as
novel target drugs. E.g. MDMA is known to have some serotonergic toxicity at
higher ends of the therapeutic window, so there are opportunities to patent a
delivery system which controls the peak plasma concentration, or a co-drug to
block some of that toxicity.

------
cnp
Please Donate to MAPS (the organization coordinating this research) if you can
-- they need funding now more than ever:
[https://store.maps.org/np/clients/maps/donation.jsp?campaign...](https://store.maps.org/np/clients/maps/donation.jsp?campaign=11)

~~~
justinpombrio
Thank you for the link. I donated, and probably wouldn't have if you hadn't.

~~~
cnp
Thank you :)

------
LouisSayers
It's good that people with serious issues can get some help via drugs like
MDMA, but I do think people should be careful.

I feel that certain groups of people are a bit flippant about drug use, and
seem eager to promote them as these great things.

As an example of why we should still remain vigilant - studies have shown MDMA
users to literally have shrunken bits of their brain.
[http://www.maps.org/news/media/2462-media-reports-of-
ecstasy...](http://www.maps.org/news/media/2462-media-reports-of-ecstasy-and-
brain-shrinkage-overblown)

I remain cautious of people that promote these things - we should know about
the side effects so we can make informed decisions.

Overall, I think it's good to open up laws to allow usage of this, but let's
not forget the people who suffer from or may be prone to suffer from drug
abuse, and maybe think twice before promoting these things to friends.

~~~
eric_h
> studies have shown MDMA users to literally have shrunken bits of their
> brain. [http://www.maps.org/news/media/2462-media-reports-of-
> ecstasy...](http://www.maps.org/news/media/2462-media-reports-of-ecstasy..).

I only had a chance to skim that article, but it is equating tablets of
ecstasy with MDMA, which is a false equivalence. "Ecstasy tablets" _usually_
contain some MDMA, but can also contain a whole bunch of other shit, including
cocaine, heroine, speed, MDA, etc. I think the jury's still out on whether
pure MDMA has the same downsides from frequent use.

~~~
taneq
And even then, there's a huge difference between "frequent recreational use"
(and it's not uncommon for recreational users to take 10+ pills in a night,
and to use every weekend) and "theraputic use". Habitual club users do tend to
get pretty fuzzy after a while but they're not using the drug in any remotely
responsible way. Taking them as a reason to keep MDMA illegal is like saying
that drunks exist and so doctors shouldn't be allowed to use alcohol swabs.

~~~
throwawayofc
I dunno about other places, but in Europe the average dose in a single tablet
is ~200mg. This is largely due to a stupid law in the Netherlands where
getting caught with a single tablet got you a slap on the wrist, but getting
caught with multiple would have them try to pin "dealer" on you. The result is
that in the past 10 years or so, the average dose per tablet went from 30mg to
200mg and I've even seen pills of 270mg (we have free, anonymous testing
labs). On the bright side, they are much less often contaminated with
amphetamines and caffeine nowadays...

AFAIK, the LD50 of MDMA isn't known, but as a frequent recreational user I can
tell you that taking over 2000mg in a single night is definitely not common. I
know a lot of people who use recreationally on a frequent basis, and none of
them will go over 400mg on a night, and even 400 is considered pretty bonkers.
Most folks who use every weekend are probably pretty new to the experience and
haven't noticed the side effects when using more than once per month.

~~~
taneq
Wow, that's way larger a dose per pill than used to be common when I got my
information. Goes to show how much local scene knowledge you need in order to
have a chance of trying these substances safely, which is one of my big gripes
with the 'war on drugs' phenomenon. Prohibition is definitely a case where the
cure is worse than the disease.

------
Overtonwindow
I think a lot of the psychotropic drugs can help us unlock new treatments.
IMO, if we can remove the morality issues from some of this research, we'll
see greater progress. I'm also hopeful that cannabis will make its way into
more research.

------
anythingnonidin
If anyone is wondering how they can help make sure this research happens, the
single most helpful thing I'm aware of is helping MAPS find people interested
in large (6 or 7 figures) donations. You could reach out to askmaps@maps.org
or via another channel if that describes you or a friend

------
anythingnonidin
I'm very interested in this stuff. See my submissions for other interesting
articles on the potential of MDMA and classic psychedelics (magic mushrooms,
LSD) to help both unwell and healthy people be happier & healthier:
[https://news.ycombinator.com/submitted?id=anythingnonidin](https://news.ycombinator.com/submitted?id=anythingnonidin)

This site has an overview of where MDMA and classic psychedelics may be
useful, and the most effective things you can do to help the science + safe
access progress:
[http://www.rethinkpsychedelics.org/](http://www.rethinkpsychedelics.org/)

------
anythingnonidin
The "MDMA Therapy" subreddit has some decent info:
[https://www.reddit.com/r/mdmatherapy/](https://www.reddit.com/r/mdmatherapy/)

------
PhasmaFelis
We're slowly realizing that there's not actually a difference between
dangerous drugs and miraculous medicines. The dose (and the circumstances)
make the poison, always.

~~~
loeg
LD50 vs effective dose still matters. Some drugs are inherently more dangerous
than others. (This is not a jab at illicit substances — tylenol is
problematic.)

But yes, we're very much realizing that DEA scheduling is not based in
evidence (and actually prevents gathering of further evidence).

~~~
Turing_Machine
Tylenol/acetaminophen/APAP/paracetamol immediately came to mind for me as
well. It's flat-out amazing to me that shit is still allowed on the market.

It hammers your liver really hard, especially in combination with alcohol. In
fact, it's the foremost cause of acute liver failure in the entire western
world.

The kicker: it doesn't even work very well. Other pain relievers are much more
effective, and have a much higher margin of safety.

~~~
0xcde4c3db
The funny thing is that if you ask the average American whether Tylenol or
aspirin is safer, they'd probably say Tylenol unless they specifically know
about the liver issue. I think this ultimately comes from acetaminophen having
remarkably few interactions, but has been spun by marketing into a general
sense of "safety".

------
dagaci
MDMA as a tool for treatment has always been obvious to me. Any drug which can
give you such a massive high, taking you so completely out of that low is a
method bringing a person more in-tune to a place they should be.

But of course and critically at the same time the user should have the right
thought processes in place for it to be effective and not something they cling
too in a recreational cycle, in my mind it should only need to be one-time
event.

------
tibbon
I wish I knew who (realistically) was against this, but supports the ability
of pharma companies to ship opiates. And why?

~~~
anythingnonidin
As far as I'm aware, there isn't really anyone strongly against it, there just
aren't enough (wealthy) people who are strongly supporting it.

The main barrier by far is funding, which my understanding is mostly comes
from large (6-7 figure) funders.

So, some "opposition":

\- Apathy

\- Desire to not spend money / pass on majority of wealth to future
generations

\- Lack of knowledge

\- Belief that donating to MDMA/psilocybin research isn't an effective way to
donate money

I think the biggest one is just wealthy people, understandably, are hesitant
to donate their money. Logically it seems many of them understand that they
won't be able to spend through it all and will still have substantial
resources for future generations, but emotionally I imagine it would be hard
to cut a $5 million check to a non-profit.

I don't think it's a lack of billionaires aware of MDMA - there should be more
than enough billionaires from the burning man crowd alone.

------
anythingnonidin
I recommend reading or listening to the book Acid Test if anyone here would
like to learn more about the therapeutic potential of MDMA and classic
psychedelics (e.g. psilocybin/magic mushrooms).

------
kristofferR
Paywall bypass:
[https://twitter.com/WSJ/status/920703548115046400](https://twitter.com/WSJ/status/920703548115046400)

~~~
dredmorbius
Also: [http://archive.is/kOj9S](http://archive.is/kOj9S)

------
DonHopkins
They put it on everything here in the Netherlands. Just ask for "Friet met
MDMAyonaise".

------
Mankhool
Paywall . . .

------
kolbe
Paywall, but I'm going to go ahead and assume the real answer is that some
drug company will get monopoly rights to sell it, and has outlined an
effective strategy to get it overprescribed at the expense of US taxpayers.
That's how it became a 'breakthrough therapy'

edit: I'm not saying it's bad to treat MDMA as a useful therapy. I'm just
saying what force was at play to change the cultural opinion.

~~~
nugga
I don't think you can patent and steal a monopoly on a drug synthesized in
1912.

~~~
trendia
Sometimes this is true, however there are many tricks that biotech companies
use to prevent generics.

The first is the very high cost ($ billions) of getting through FDA approval
for a drug. Once a company has done this approval, then other companies must
show drug equivalence in order to produce generics that can stand in. They
have to wait for the patents to expire, or figure out how to get around
existing patents, but that's still not enough. They must show that _their_
drug is equivalent to the existing drug. But this is not easy task, because
the incumbent will do everything they can to prevent anyone else from getting
the drug for research purposes. (e.g. the incumbent will claim that a
particular company trying to get the drug does not fit their safety protocols,
and thus refuse to provide the drug. Because the company cannot get access to
the drug, they can't prove equivalence.)

Another method is that a prescription for one drug does _not_ always guarantee
that the prescription can be used for a generic drug of the same sort [0]. The
incumbent company will spend lots on marketing by buying lunch for doctors,
giving them notepads and pens, etc. Then, the doctor will write a prescription
for that drug as write "Dispense as Written." This prevents the pharmacist
from providing a generic alternative, even if they're biologically equivalent!

A final method is to develop a drug with a particular injection mechanism. For
instance, if a drug company puts MDMA in a patch, then they can get a patent
for the combination MDMA + patch, get approval, and then get doctors to
prescribe it. (Maybe it provides a small dose over a long period?) This can
occur even if MDMA was first synthesized a century ago. The prescription for
the patch cannot be used for a pill form, or vice versa. This guarantees the
drug company revenue as long as they can convince doctors to prescribe it.

So, to make a long story short, there are a lot of ways that drug companies
guarantee their $$$ and prevent competitors from eating their lunch.

[0] [https://www.washingtonpost.com/national/some-doctors-
insist-...](https://www.washingtonpost.com/national/some-doctors-insist-on-
brand-name-drugs-even-when-cheaper-generics-are-
available/2011/06/13/gIQAmC0L9H_story.html)

~~~
refurb
You're ignoring how hard it is to do a lot of those things.

First off, getting a new drug approved is not "preventing generics". Generics
_need_ a new drug approve before they can get their generic approved (since
they based their application off the original drug's data). This is a feature,
not a flaw of the system. Without some guarantee of market exclusivity, nobody
will spend on R&D to get approval.

Second, yes, a doctor can write "DAW - dispense as written", however most
insurance companies won't cover the originator drug if a generic is available.
The patient is then on the hook for the entire cost. That's a strong incentive
to go generic.

Finally, unless the new administration method (patch, etc) has some benefit
over the generic, doctors won't prescribe it and insurance company's won't
cover it.

~~~
monocasa
> Second, yes, a doctor can write "DAW - dispense as written", however most
> insurance companies won't cover the originator drug if a generic is
> available. The patient is then on the hook for the entire cost. That's a
> strong incentive to go generic.

I've heard rumors of the insurance companies backing off of this stance in the
past few years. Essentially, since the ACA puts a hard cap on profit margins,
insurance companies are looking for ways to spend more so they can have the
same margins on a bigger pie and still increase real profit year after year.
Policies like relaxing generic vs proprietary let's them achieve that in a
controlled manner.

~~~
refurb
Wouldn't that take collusion between insurance companies? If I'm Google and
United says "you're premium went up 20% this year", but Aetna is only 10%,
Google is going to change insurance companies.

~~~
monocasa
Proving collusion in the modern environment is an uphill battle.

Just look at the telecommunications industry.

