Years ago researchers thought that psychedelic medicines would be useful for treating many psychiatric conditions. Then concerns about recreational use, negative public opinion, and the political “war on drugs” resulted in psychedelic medicines like MDMA and psilocybin being made Schedule One drugs. This categorization means that a drug has no legitimate treatment purpose and is dangerous, typically addictive. The popularity of the “party drug” ecstasy did not help public perception in this regard. Nevertheless, today psychedelics appear to be heading toward approval for treating PTSD, depression, and substance abuse disorders. What are the dangers of a psychedelic medicine for treating PTSD?
Status of Research on Psychedelics for Treatment Purposes
In 2017 two psychedelic medicines were granted breakthrough drug status by the FDA (US Food and Drug Administration). This status allows promising medicines to be fast tracked through the FDA approval process. Both MDMA and psilocybin have been progressing through clinical research trials on their way to being approved as legal treatments. MDMA is working toward approval for treatment of PTSD while psilocybin is making its way toward approval for treatment of depression. In both cases, the medicines are expected to be used as adjunctive treatment along with coaching or psychotherapy. MDMA is on the cusp of approval while psilocybin is likely a year or so behind. The fact that these two psychedelic medicines have been under investigation for six years tells one just how demanding the FDA approval process is for proving that a medicine is both safe and effective.
What Is MDMA?
The psychedelic medicine that may soon be used as a standard treatment for PTSD is MDMA. MDMA is short for 3,4-Methylenedioxymethamphetamine. It is a stimulant that is related to amphetamine. It has hallucinogenic properties and goes by the “street names” mandy, molly, and ecstasy. Users take it to experience more energy, pleasure and altered sensations. It also tends to increase empathy in those who use it. When this psychedelic medicine has been thoroughly investigated, it was found to provide amazing results in helping to treat post-traumatic stress disorder (PTSD). Unlike antidepressants that are also used for PTSD treatment, MDMA works with one or two doses as opposed to requiring daily meds for weeks, months or even years. MDMA facilitates the growth of nerve branches or neurons in the brain. This, in turn, appears to be responsible for much of how it works in helping make PTSD patients better.
How Dangerous Is Ecstasy?
MDMA helps make PTSD patients better and allows them to stay better for years, if not forever. So, why is it not yet approved for treating PTSD? The FDA is tasked with two things. It has to make certain that any medicine that doctors can prescribe for or directly give to patients is safe in the doses and frequency in which it will be used. That is first and foremost. Then it must prove that the medicine works in doing what it is meant to do. MDMA goes by the “street name” ecstasy and ecstasy has some risks.
Outside of the research setting MDMA is an illegal drug. It is a stimulant (like amphetamine) that raises blood pressure, speeds up the heart, can raise body temperature, and can lead to seizures and death. Because ecstasy is often used at parties where people may be dancing (exercising) in a hot room, the drug can lead to dehydration. Because ecstasy used for recreation is made illegally, a person may be getting something totally different, twice three times the appropriate dose, or a whole host of other, potentially dangerous, drugs along with the MDMA they want.
The lethal dose of MDMA is generally in the range of three to four times what is normally used for recreation as noted in a report from the BBC. A lethal dose of aspirin is typically thirty to forty times the standard dose. Thus, the “therapeutic window” for this drug is smaller than with a common medicine like aspirin. A therapeutic window is the range of dose and frequency that is safe and effective while avoiding side effects.
Is MDMA for PTSD Treatment Safe?
It should be noted that when ecstasy is used recreationally the pills are typically 60 to 120 mg. Meanwhile, in the research setting, 30mg, 75mg, and 125 mg doses have been compared with the most effective treatment seen at a single 125 mg dose. Because one would not expect professionals treating PTSD to use anything but a standard and approved dose, we should expect that this psychedelic medicine will be safe in standard use. The concern will be with misuse such as when the medicine is used inappropriately.