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.
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.
After watching the 60 minutes expose on the DEO and how they helped cause the opioid epidemic, the DEO literally does the opposite of what they're supposed to. They make it easier to get dangerous drugs into the wrong hands, while preventing helpful drugs to those who need it most.
>Ex-DEA agent: Opioid crisis fueled by drug industry and Congress
Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities -- knowing that people were dying -- and says industry lobbyists and Congress derailed the DEA's efforts to stop it
To add to the other comment, I highly recommend 'Acid Test' to get an overview of the history and potential of MDMA + other drugs like magic mushrooms.
Thanks for this. I'm curious to hear why something that has such remarkable potential to improve lives, has somehow been channeled into a social taboo.
When something competes with established channels for individual fulfillment, the people who control those channels (politicians, manufacturers, priests, ministers) will oppose, vilify, and demonize it.
Yeah this is essentially it coming full circle. This book [0] is a great read on the history and use of Ecstasy and covers it's early therapeutic uses and how it progressed to party drug.
> I mean, it won't change your personality or anything like that.
I was on MDMA in 2000 when I finally saw through my own bigotry. I had been raised with a particular set of values about a group due to the prejudice of a parent. I have always attributed that personal breakthrough to the drug. This still might have occurred naturally, albeit at a slower rate, but it shattered my worldview in a very positive way in one night.
I could go on about personality changes that were directly linked to another chemical, but the point is that just because it hasn’t happened to you doesn’t mean that it hasn’t happened to someone else.
Disagree - I suffered crippling social anxiety and paranoia as a teenager. I was a lonely and isolated child. First time I tried MDMA in a social setting was like stepping into another body where strangers weren't all laughing at me/talking about me behind my back. I was able to effortlessly start conversations with random people and was surprised at the positive response.
That one night was a huge, huge catalyst in overcoming my social anxiety and I can't overstate how long-lasting, life changing and valuable the experience was for me.
MDMA is an extremely powerful substance and I'm excited to see it being taken seriously for therapy.
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.
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.
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.
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.
Given the number of suicides among our veterans and other PTSD suffers, I am in awe of the idiocy of not funding a very likely successful treatment. I absolutely do not like drugs (seen too many people go right into oblivion), but even with that, I cannot understand not giving it a chance in a clinical study. It’s damn near criminal.
You should really break the category "drugs" down a bit. Psychedelics and entheogens are so far from things like heroin, cocaine and methamphetamine (which I don't like either) that it is a bit silly to lump them together.
Just for reference, shamans refer to Ayahausca as medicine.
Sorry, I just used the generic term for illegal. I lived on a rez so Peyote was a religious rights issue. Crack & meth really have no use in society at all and the damage I've seen still gives me nightmares. Plus, meth is actually a physical danger to those around the maker. Unrefined cocaine leaves are used as an altitude aid, so I really cannot say much bad there (refined cocaine users are a problem).
I don't think I've ever encountered a shroom user and I'm fine with studies. I really don't like MJ because it does ruin people's lives around here, but I get the legalization (well, sorta, kinda legal) and I guess some people can handle it fine putting in the same boat as alcohol for me. I'm a bit perturbed because we just got smoking down and now something that smells worse is here. I was hoping people would flock to some vaping solution[1], but we got smokers who can cause a contact high. As a North Dakotan who remembers some history, I look forward to hemp being grown again in the northern plains.
I live in a place where people have stolen hand soap and drained air conditioners to get a buzz, so please forgive my default is "not good".
1) whatever idiot thought e-cigarette was a good name should be held to ridicule.
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.
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.
The most common additives are caffeine and methamphetamine, but 50%+ of the time, the pills are uncut MDMA. And these stats are distorted pessimistically, as people who are confident in what they are buying aren't likely to send drugs they paid for off to be tested.
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.
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.
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.
> Additional commentary: Upon examining this report, human neuroscience researcher Matthew Johnson noted that the researchers did not do a convincing job at "matching" the ecstasy users and control participants on other drug use. The ecstasy users had considerably more use of other drugs, but the statistical tests of whether the groups differed in this respect lacked sufficient power to detect differences in drug use.
I agree. Not the brain stuff, but the slippery-drug-gateslope theory.
It's extremely unlikely that a single dose of MDMA will cause lasting brain damage.
What is problematic, however, is that it's probably much more of a gateway drug than, for example, grass. The path from MDMA to Speed to Meth is shallow enough that some non-neglible percentage of people will probably follow it.
Not everyone, obviously. But if it's 2% or 3%, that may not be worth it.
which leads to the only logical conclusion that you should totally try MDMA if you're the type of person that would never try MDMA :)
As opposed to MDMA grass doesn't have the full-blown in-your face effects. Just as it's way easier to become an alcoholic by drinking a few beers daily than by getting drunk off a bottle of vodka.
Moreover - the potential for abuse with grass here is way wider, since it's not that easy to come to work with the MDMA eyeballs, while getting a few puffs during lunchtime isn't such a big deal in certain professions.
The problem with drugs are the people who never tried them - rather than at least just shutting up and voting to legalise the research (to look at the maths), they end up with the same discussion having little evidence _every_single_time_.
I think it's more that the settings in which you use (and buy) MDMA is closer to "harder" drugs than weed.
Also it gets you into the whole party lifestyle. I've personnally used it only twice a few years ago, but the people I took it with (most of us first timers) now spend a huge amount of time planning their trips and talking about drugs, and moved on to LSD and different mixes. Tbh I think it's sad that this has become such a big part of their fun. I enjoyed it, and it definitely changed me, but even though I don't worry at all for them, I don't think that's a very sane way to spend week ends.
I've never been interested in smoking weed, and my edible experience was not fun enough to encourage me to continue there either. But still, I didnt feel so "close" to the drugs world when I was hanging around stoner friends than party-goers.
Never tried MDMA, so not to be some drug defender here. But I think its worth noting that study is a sampling of people who have used an average of 281 "MDMA" tablets over the past 6 years.
It could be that MDMA abuse just has negative affects versus something in a controlled setting for therapy.
Just anecdotally, I was a rave DJ for 5-6 years and rolled almost weekly for several years of that time frame, along with mixing and matching various other club drugs pretty frequently.
I was a mess as a human being for a big chunk of that time frame, but ten years later I’m a senior software developer making very good money, with a wife and kids. As far as I can tell, I’ve had zero long term negative effects from years of poly drug abuse, even though if you had talked to me at the time, you’d have thought I was a drug casualty. (Though I was working as a network engineer and getting promotions and raises the entire time.)
I wouldn’t _recommend_ going crazy with it like i did, but part of the problem I had was that all of the scare tactics I had heard were transparent lies, and the real issues around drug use were much more subtle that I had need prepared to look out for.
During my final years of the university I had spent 1 to 2 years being absolutely stoned - even had the same routine described in Infinite Jest, where I would plan for the week, how much and when should I smoke.
Over that time those who would notice me being sober would assume I was actually stoned, due to the visible changes in my behaviour. Again, not a single person knew me sober: not coworkers and neither any of my friends.
I had successfully finished the university since then and I am currently working a senior software engineer in London City.
Neither would I recommend trying the same - but what I did learn was that anything officially stated about that drug is way far away from the truth, and that _is_ the problem. The devil is in the subtleties.
Not to miminize, but tobacco and alcohol also have that effect in some scenarios.
Many drugs have powerful side effects — but we balance those effects against benefits. Chemotherapy is poison, yet it’s judged to be better than cancer, to take an extreme example.
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.
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
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
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/
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.
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).
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.
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".
What pain relievers are much more effective than acetaminophen, and much higher in terms of safety? NSAIDs are a huge cause of bleeding and renal insufficiency. Tylenol is actually pretty good at treating pain in appropriate doses. Definitely a bummer when people overdose on it, fulminant liver failure is very unpleasant, but we have a great antidote for it.
we've known this for a very long time that legality of drugs had very little to do with their actual danger to society or individuals and much more to do with fear mongering and racism
Fear mongering, as we have the same attitude in the UK, but not the race divide that the States has (we have a very similar divide along the lines of class however).
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.
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.
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).
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.
It's not the sort of drug that gets prescribed regularly, you're only supposed to do it once, or maybe a few times at most. Therefore it doesn't fit their sales model, hence their probable hostility to the drug, and it's the same with Ketamine, LSD etc too
That's just not true. Opioids are a standard part of pain management. There are plenty of people who will be taking opioids as a breakthrough pain management technique for the foreseeable future. That makes it quite different from a "1 and done" type prescription model.
"Though Percocet and other oxycodone-containing medications were originally used only for acute (short-term) pain, changes in government recommendations and aggressive marketing by pharmaceutical companies have led to a dramatic increase in the use of this drug in patients with chronic (long-term) pain since the 1990s."
Pain doesn't easily divide up in to long-term and short term. What do you call someone who typically manages their pain with tylenol and mental techniques, but sometimes has to use opioids to make it through the day? Many people with chronic pain find themselves in this situation, for the rest of their life.
Also, beware of false causation. The (extremely detrimental) effects of pain were not well circulated in the medical profession in the '80s. The more aggressive pain management that has occurred since is at least in part due to this sea change, and not merely "aggressive marketing". The "changes in government recommendations" did not occur by happenstance, nor were they solely motivated by pharma marketers.
You can actually use opiods for a protracted period without severe side effects except constipation, and of course posisivle addiction. But physically it’s quite safe if dosed properly and has no mental side effects really. MDMA can have severe mental and physical side effects when used frequently or sometimes just once.
Doubtful, you can just charge more for it in that case. Lots of drugs are not supposed to be taken long-term. It doesn't necessarily make it a net negative for the pharma company.
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.
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.
> 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.
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.
The first chemical entity approved by the FDA gets data exclusivity - that is, no other company is allowed to use the originator's data to get their generic approved. I think the standard is 5 years, with rare disease drugs getting 7 year.
I'm not saying it shouldn't be a legal drug. I'm just guessing at what the "force" was at play here to get the change to come about. The psychological benefits of E have been highly advocated for a while.
Posting like that is a bannable offense on HN. We're trying for a (much!) higher level of quality here, though of course we don't always succeed at that. Would you please read and follow https://news.ycombinator.com/newsguidelines.html when using this site?
I normally would have banned a new account that posted like this, but https://news.ycombinator.com/item?id=15406879 looks pretty good, so we'll assume you want to use HN as intended. Please do read those guidelines though!
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.