Encore episode: MDMA-Assisted Therapy for PTSD with Rick Doblin, PhD

In this episode of the Psychedelic Medicine Podcast, Rick Doblin joins to discuss the past, present, and future of MDMA-assisted therapy. Rick Doblin is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies. He received his doctorate in public policy from Harvard and has also studied under the father of transpersonal psychology Stanislav Grof. Through MAPS, Rick aspires to develop legal contexts for beneficial uses of psychedelics and marijuana as prescription medicines, but also for self-development and personal growth in otherwise healthy individuals.

Rick begins this wide-ranging conversation discussing the early days of MDMA. The compound was originally synthesized by famed chemist Alexander "Sasha" Shulgin and, unlike the classic serotonergic psychedelics, it was not scheduled under the Controlled Substances Act in the early 70s. It was during this period of legality that therapeutic uses of MDMA were first developed and it was only later that the drug became repurposed as a recreational substance to be used in social settings, which consequently led to its emergency scheduling by the DEA.

Rick recalls his own initial experiences with the empathogenic compound, stating that he was initially skeptical of its value, prior to gaining first-hand experience. Following this experience, however, he became convinced of its therapeutic potential and he shares some of his own early experiences of using MDMA to help people heal, including a very touching tale of his own grandmother's struggle with depression.

From here, Rick discusses the founding of MAPS and his decision to pursue education in policy in order to better understand strategies for furthering MDMA-therapy even while living under prohibition. Since that time, MAPS has gone on to do incredibly impactful work in developing studies researching the safety and efficacy of MDMA-assisted therapy, specifically for post-traumatic stress disorder. Rick shares the progression of these studies, highlighting the results from the most recent phase three investigations which are the last step prior to FDA approval for the therapeutic protocol. These studies show high statistical significance and an amazing effect size resulting from MDMA-assisted therapy, with results being mirrored at all research locations and showing durability over time.

Because of this amazing progress, Rick believes we are at the final stretch prior to full FDA approval for MDMA use in a therapeutic context for PTSD, and subsequent rescheduling of the substance by the DEA, which he believes will take place in mid to late 2023. This development will have broad global impacts, spurring other countries to promptly follow suit.

Rick closes out this discussion by emphasizing the need for mass mental health in our day and age, and sharing MAPS' lofty goals of training thousands of therapists to hopefully bring psychedelic therapy to millions of patients in the coming decades.

In this episode:

• Rick Doblin's personal journey
• The history of the MDMA's synthesis and legality
• Rick's first experiences with MDMA and early experiments with MDMA therapy
• MAPS' "two-pronged" strategy for mass mental health
• Early efforts to get an MDMA therapy protocol approved by the FDA following prohibition
• The politics of concerns about MDMA neurotoxicity and how this impacted MAPS' early approach
• The results of the first phase three studies of MDMA for PTSD
• How FDA approval of MDMA will lead to an international cascade of approval and rescheduling
• Rick's predictions for psychedelic medicine in the years to come

Quotes:

"What a lot of people don't know is that MDMA was a therapy drug before it was a party drug. And it was the party drug nature of it that really got it criminalized." [7:38]

"Seeing what it was like when it was legal and experiencing that, and experiencing situations where people would take it, the kind of experiences and healings, and learnings that people would have, was amazing." [19:12]

"What we need is, I believe, legal access to medicinal MDMA, covered by insurance, by trained professionals, and psychedelic clinics. And we also need a whole different kind of drug policy for non-medical use that involves honest drug education, access to pure substances, harm reduction, peer support, and also treatment on demand." [21:08]

"The irony here is that the first legal move against MDMA was illegal. The DEA did not have the authority to emergency schedule drugs." [23:43]

"FDA is legally bound to approve MDMA for PTSD if these [phase 3] studies generate statistically significant evidence of efficacy, and there are no new safety problems." [40:27]

"We think by the third quarter of 2023 we will have FDA approval assuming the second phase 3 study goes well. And then by the fourth quarter, the DEA has to reschedule [MDMA]." [51:18]

"What's even greater is the 12-month follow-up data was 67% no longer had PTSD. So people kept getting better—not only was it durable, but they kept getting better." [55:00]

"The thing to emphasize here is that MDMA is not the treatment. The treatment is therapy. The MDMA makes the therapy more effective and there can be different kinds of therapy that are used with it." [1:01:38]

Links:

MAPS website

Rick Doblin on Twitter

Trip of Compassion Documentary

The Way of the Psychonaut Books by Stanislav Grof

Upcoming MAPS Psychedelic Science Conference 2023

Becoming an MDMA-Assisted Therapist with Shannon Carlin, MA, LMFT

Psychedelic Medicine Association

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