04/26/16

MDMA—Not!

Ecstasy tablets © portokalis | 123rf.com

Ecstasy tablets © portokalis | 123rf.com

There are a handful of names for 3,4-methylenedioxymethamphetamine (MDMA), including: E, X, XTC, Rolls, Adam, Molly and Ecstasy. The pro-drug website Erowid noted it is one of the most popular recreational psychoactives, known for its euphoric, stimulant and empathogenic (feelings of oneness, emotional openness, empathy or sympathy) effects. This last effect indicates it has a past and current history of use in psychotherapy. But when you see a warning that, “Ecstasy tablets are notoriously impure, often containing chemicals other than MDMA,” be forewarned you may not be actually using MDMA.

The MDMA timeline on Erowid indicated MDMA was first synthesized and patented by Merck Pharmaceuticals in 1912. And the first animal testing of MDMA occurred at Merck in 1927. An article titled, ‘The Origin of MDMA (“Ecstasy”)’ indicated the 1912 Merck patent was a procedural patent, meaning MDMA was a precursor compound for another therapeutic and was not isolated as a drug in its own right. “Obviously, it was never intended for sale. MDMA was not tested pharmacologically in 1912.” The 1927 experiments were only aimed at exploring the potential pharmacological actions of MDMA. You can also read about MDMA and it history here on Wikipedia.

The first scientific paper on MDMA wasn’t published until 1960—in Polish. Alexander Shulgin resynthesized MDMA in 1965 while working at Dole Pharmaceuticals, but did not try it on himself at this time. Between 1967 and 1975 there were reports of small underground batches of MDMA being used recreationally, but Erowid said it had no clear documentation of its use before the mid 1970s. It didn’t become widely available as a street drug until around 1977.

Schulgin first heard of the psychoactive effects of MDMA from a student, and he tried it himself in September of 1976. He then reported on MDMA at a conference in December of 1976. Along with David Nichols, Schulgin wrote and published a report on the drug’s psychoactive effects in 1978. They described MDMA as inducing “’an easily controlled altered state of consciousness with emotional and sensual overtones”’ comparable ‘to marijuana, to psilocybin devoid of the hallucinatory component, or to low levels of MDA.’” Schugin referred to MDMA as “window”, because it allowed users to strip away habits and perceive the world clearly.

Because of its disinhibiting effects, Schulgin thought it could be useful in psychotherapy, so in 1977 he gave some to Leo Zeff, a psychotherapist. Zeff was so impressed with the effects, he came out of semi-retirement to promote its therapeutic use. Reportedly, he eventually trained an estimated four thousand therapists in the therapeutic use of MDMA. Zeff referred to MDMA as “Adam”, as he saw it putting users into a state of “primordial innocence.” It is believed that MDMA eliminates fear and increases communication in therapeutic users.

Concerned that MDMA would become an illegal substance like LSD and mescaline, early advocates tried unsuccessfully to restrict the available information and use of MDMA while they conducted informal research on its properties. By the late 1970s, there was a small recreational market for MDMA. By the early 1980s, it began to take hold as a “club drug” in places like Studio 54.

In 1984, Michael Clegg put together some financial backing, coined the term “Ecstasy” for MDMA, and mass-produced it in a Texas lab. “Ecstasy parties” were advertised at bars and discos. MDMA use quickly became a common sight on college campuses. “By May 1985, MDMA use was widespread in California, Texas, southern Florida, and the northeastern United States.”

Concern over the recreational use of MDMA resulted in its temporary placement as a Schedule I controlled substance on July 1, 1985. As a result of a hearing challenging the placement of MDMA as a Schedule I controlled substance, it was removed from its Schedule I status because of an improper procedure when it was originally scheduled on December 22, 1987. Within a short period of time, the DEA administrator reclassified MDMA as Schedule I, and it was permanently placed as a Schedule I controlled substance on March 23, 1988.

Ecstasy has remained a common recreational substance, particularly at dance clubs and raves. But it also persisted as a potential psychotherapeutic agent. The non-profit organization MAPS—Multidisciplinary Association for Psychedelic Studies—is currently funding clinical trials of MDMA as a “tool to assist psychotherapy” in the treatment of PTSD. Rick Doblin, the executive director of MAPS, founded it in 1986. His pre-MAPS organization, Earth Metabolic Design, held a conference on MDMA in March of 1985, in the midst of the fight over whether MDMA should become an illicit controlled substance.

MAPS is undertaking a roughly $20 million plan to make MDMA into a Food and Drug Administration (FDA)-approved prescription medicine by 2021, and is currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. The idea of using MDMA to assist psychotherapy of any kind for any specific clinical indication has long been in the public domain.

The development of psychoactive substances like MDMA, LSD, Ibogaine and Ayahusca as psychotherapeutic “tools” has gained momentum in recent years. In part, this is because of the growth of concerns over the adverse effects and long-term use of FDA approved medications like antidepressants and antipsychotics. MAPS supports research into the therapeutic use of each of the above-named psychoactive substances. The following quote illustrates how MAPS presents the therapeutic benefits of MDMA-assisted psychotherapy: “MDMA is only administered a few times, unlike most medications for mental illnesses which are often taken daily for years, and sometimes forever.”

Along with Erowid, MAPS cautions that substances sold as “Ecstasy” or “molly” may not be pure MDMA. “Substances sold on the street under these names may contain MDMA, but frequently also contain unknown and/or dangerous adulterants.” The rise of novel or new psychoactive substances (NPS) such as “bath salts” has meant that many partygoers who think they are using MDMA aren’t. Media outlets such as Newsweek and The Fix have reported on a recently published study in the journal Drug and Alcohol Dependence that tested hair samples from ecstasy users for the presence of NPS. The lead author of the study, Joseph Palmer, said in an NYU press release on his research that:

Given the sharp rise in poisonings and recent deaths at dance festivals related to ecstasy use, research was needed to examine whether nightclub/festival attendees who use ecstasy or Molly have been unintentionally or unknowingly using “bath salts.”

The researchers surveyed young adults outside of nightclubs and dance festivals in the summer of 2015 about their use of ecstasy and other drugs.  The participants were asked if they had knowingly used any of a list of more than 35 NPS; and whether or not they had knowingly used ecstasy, MDMA or “molly.” Then they were asked if they would submit a lock of their hair for the researchers to test for NPS. “We collected hair samples from about a quarter of the survey sample to be tested for novel drugs.”

A lot of people laughed when they gave us their hair saying things like “I don’t use bath salts; I’m not a zombie who eats people’s faces.”

However, the researchers found that among individuals who reported they had not knowingly used bath salts or some unknown substance, 40% tested positive for “bath salts” and other NPS. Among participants reporting they had used ecstasy, half the samples tested positive for MDMA and half tested positive for bath salts and other NPS. One sample tested positive for alpha-PVP, flakka.

Ecstasy wasn’t always such a dangerous drug, but it is becoming increasingly risky because it has become so adulterated with new drugs that users and the scientific community alike know very little about. . . .   Users need to be aware that what they are taking may not be MDMA.

12/22/14

Back to the Future with Psychedelics

© Zhuxi1984 | Dreamstime.com - Back To The Future Photo

© Zhuxi1984 | Dreamstime.com – Back To The Future Photo

“I am 100 percent in favor of the intelligent use of drugs, and 1,000 percent against the thoughtless use of them, whether caffeine or LSD.” (Timothy Leary, in Chaos and Cyber Culture)

We’re going “back to the future” with recent research into the therapeutic benefits of hallucinogens for treating alcoholism and mood disorders. (See additional stories here and here; and a previous blog, “As Harmless as Aspirin?”) Classical hallucinogens such as LSD, mescaline or psilocybin, and dissociative anesthetics such as ketamine and PCP might be “useful” in the treatment of major depression, anxiety disorders and OCD. A recent study concluded: “There was evidence for a beneficial effect of LSD on alcohol misuse.” A single dose of LSD was found to be associated with a decrease in alcohol misuse. Another longitudinal study suggested that: “hallucinogens may promote alcohol and drug abstinence and prosocial behavior in a population with high rates of recidivism [with individuals on probation or parole].”

An issue of Current Drug Abuse Reviews (volume 6, number 1, 2013) was devoted to the investigation of psychedelics and their potential as therapeutic agents in the treatment of addiction. Several different articles suggested the therapeutic benefits of a variety of psychoactive substances—some classics and some newer ones.

Rick Doblin, in “Psychedelic-Assisted Psychotherapy for the Treatment of Addiction,” said: “There are multiple frameworks for understanding how psychedelic therapy can alleviate substance abuse.” He noted that the idea that psychedelics can be helpful in combating drug abuse conflicts with “the notion that psychedelic drug use is inherently wrong.”

Michael Bogenschutz of the University of New Mexico Health Sciences Center suggested that sacramental use of classic hallucinogens, like the Native American Church’s use of peyote, “is strongly associated with decreased alcohol and drug use.”

Lisa Jerome and others lobbied for studies that tested MDMA-assisted psychotherapy in people with an active substance use disorder. “It appears that MDMA, like classic psychedelics, may have a place in addressing substance abuse or dependence, which could be linked to its pharmacology or its psychological effects.”

Ayahuasca, a psychotropic brew prepared from an Amazonian vine and bush, may be associated with reduced substance use and “improvements in several cognitive and behavioral states.”

Thomas Kingsley Brown reported that ibogaine, a psychoactive alkaloid found in a rainforest shrub of West Central Africa, helps with withdrawal symptoms and reduces drug cravings..

A study of ayahuasca-assisted treatment for substance use problems by Gerald Thomas and others suggested that it was associated with significant improvements in several factors related to problematic substance use. While this particular study occurred in Canada, ayahuasca has been used as a remedy to help overcome drug addictions in Peru and Brazil. “Although these programs claim improved health outcomes for patients who complete them, neither has been evaluated with sufficient scientific rigor to provide definitive evidence of the success of their approaches.”

Ibogaine is not used in the US to treat addiction because of its severe side effects, which include hallucinations, bradycardia (slow heart rate), whole-body tremors and ataxia (lack of muscle control during voluntary movements). It also had cerebellar toxicity with high doses in rats. Nevertheless, it is a growing form of treatment outside the US. A subculture of ibogaine clinics has sprung up in Mexico. Read about a trip to one here.

A synthetic derivative of ibogaine, 18-MC, has been developed and is said to show promise. It resulted in “a long-lasting decrease in ethanol, morphine, cocaine, methamphetamine and nicotine self-administration [in rats], and attenuation [decrease] of opioid withdrawal symptoms.” Significantly, it is not expected to have hallucinogenic effects and does not have the negative side effects noted above with ibogaine.

In 2012 Savant HWP, a privately-owned pharmaceutical company in California, received a three-year grant from the National Institute on Drug Abuse (NIDA) for the pre-clinical development of 18-MC. Stanley Glick, the scientific founder of Savant and a long time researcher with ibogaine, said: “18-MC is likely to be the first of a new generation of agents effective against a broad spectrum of addictions—from hard drugs such as heroin and cocaine, to alcohol, nicotine and even sugary, high-fat foods, possibly reducing obesity rates.” On September 23rd of 2014 Savant announced they had begun human safety clinical trials on 18-MC. “Savant HWP plans to develop 18-MC as a treatment for many forms of addiction and compulsive behavior, with an initial focus on cocaine and opiate dependencies.”

The so-called “psychedelic treatment” approach, based on the original work of Humpry Osmond, uses pre and post therapeutic sessions and one large dose of your hallucinogen-of-choice (LSD, ayahuasca, psilocybin, mescaline). The spiritual, therapeutic goal is captured here by Aldous Huxley’s description of his experience with mescaline in The Doors of Perception:

The man who comes back through the Door in the Wall will never be quite the same as the man who went out. He will be wiser but less cocksure, happier but less self-satisfied, humbler in acknowledging his ignorance yet better equipped to understand the relationship of words to things, of systematic reasoning to the unfathomable Mystery which it tries, forever vainly, to comprehend.

But we should remember the warnings of Albert Hofmann, the inventor of LSD, who cautioned not to underestimate the potential negative consequences of a deliberate provocation of mystical experiences with hallucinogens like LSD. “Wrong and inappropriate use has caused LSD to become my problem child.” In the “LSD state” the boundaries between the self and the outer world effectively disappear. “A portion of the self overflows into the outer world. . . . This can be perceived as a bless[ing], or as a demonic transformation imbued with terror.”