Front Burner - MDMA: from ‘club drug’ to the doctor's office

Episode Date: July 26, 2023

Australia is leading the way on normalizing the use of some psychedelics. The country’s medical regulator has approved M-D-M-A for use for people suffering from PTSD. Regulators in the US – just last month – published guidance into the use of psychedelics for possible use treating some medical conditions. How does a drug, known for its use on the dance floor, make its way to the medicine cabinet? To find out more about all this we have Rachel Nuwer on the pod today. She’s a freelance journalist and the author of “I Feel Love: MDMA and the quest for connection in a fractured world." For transcripts of this series, please visit: https://www.cbc.ca/radio/frontburner/transcripts

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hey everyone, Tamara here. So before we begin, I just want to let you know that we've started putting the show on YouTube every day. Lots of people are listening to podcasts there, so it just made sense. You'll still be able to find us on all the podcast apps, but if you want to listen on YouTube, just search for the CBC Podcast channel and hit subscribe. You can also find Commotion there,

the arts and culture podcast hosted by friend of the show Elamin Abdelmahmoud. Okay, that's it. Hope you liked today's episode. So MDMA is seeing a bit of a rebranding. Most people know it as a party drug that makes you feel really happy. And it's never really disappeared from clubs. But it is illegal. And it was once demonized by anti-drug campaigners as a substance that eats holes in your brain. We're seeing the widespread abuse of MDMA, a drug called ecstasy. And they think it's harmless. They think it's a hug drug.

And yet science-based examination suggests that this drug may have permanent impairment of neurochemical function of the brain, never mind the possibility of dropping dead the first time you use it. But before it became popular at raves and festivals, it was used by therapists. And now it's having a bit of a full circle moment. Authorized psychiatrists are allowed to prescribe medicines containing the psychedelic substances psilocybin and MDMA. Earlier this month, Australia became the first country in the world

to declare MDMA a legal medicine. Psilocybin is accessible to people with treatment-resistant depression, while MDMA can be used for PTSD. In the U.S., any day now, a team of neuroscientists who are part of the Multidisciplinary Association of Psychedelic Studies could publish their findings on phase three clinical trials for MDMA as treatment for PTSD, the last hurdle before FDA approval. That means it could become a legal treatment as early as this year. It's not that people just had a blissed out experience, felt great about the world

and they were cured. But a lot of the time it was revisiting the trauma. It was painful, difficult experience, but the MDMA seemed to make it possible for them to do it effectively. In Canada, psychedelics companies and some doctors are hoping Ottawa will also authorize MDMA to be prescribed for treatment-resistant PTSD through a special access program. In February, Health Canada issued instructions to healthcare practitioners who are looking to get MDMA for their patients. Rachel Neuer is a journalist who's been reporting on the therapeutic potential of MDMA and recently wrote a book called I Feel Love, MDMA and the Quest for Connection in a Fractured World.

I'm going to talk to her today about the fascinating history of MDMA and what the research shows about its potential medical benefits. Hi, Rachel. Welcome. Thank you so much for having me. So I was wondering if we could start by going back to the pandemic, which is a time none of us really want to talk about. But that's when this all started for you, right? We were all in lockdown and you were feeling disconnected. I think a lot of us were and you decided to do some Molly. And what did that do for you? Love it. We're just jumping right into it. Yep. Yes. World. I am a drug user. Well, yeah, I was here stuck in New York City during lockdown. You know, this is like April 2020, the really height of uncertainty and anxiety. And my husband and I and a friend who was in our pod, our quarantine pod, decided to

do some Molly. And normally when I do Molly, I do it in a club. It's just like a really great time. It makes me feel good. But in this particular instance, there was more therapeutic overtones than I'm used to. I really felt connected to everybody around the world who was going through this same period of just fear and uncertainty and disconnection, and especially to people who had lost loved ones.

But I was also turning over in my own mind some issues that I'd been having with my career, with the direction my life was taking. I'd been craving a new challenge and wanting to just try something new. And in that moment, sitting on my couch while I was on Molly, I realized, hey, I could write a book about Molly. So that's really where the idea for this book came to be. Yeah. I wonder, for people who've never done it, could you describe what taking MDMA feels like on a physical level and mentally as well? Sure. I've got to caveat my answer and say that I've never done MDMA in a formal therapeutic context. And people do say that in therapy, it really doesn't feel like ecstasy. They say,

I don't know why it's called ecstasy. This is really hard work. So I can't speak to that subjective experience myself. When you're on MDMA in a more recreational or just non-therapeutic setting, whether that's at home with a partner, having a conversation or at a big warehouse rave. The first thing I usually notice that kind of hints that it's starting to work is that I find myself just smiling, smiling for no reason, just really genuinely smiling, which isn't something I normally do when I'm just standing around. Then it begins, you kind of go up this, they call it like a plateau. So the feelings start coming on. And then once you plateau, like you hit the real MDMA high, it's waves of euphoria, just sort of this really nice feeling. It's really hard to describe in words, but that's why people call recreational

use of MDMA rolling. It's this rolling feeling of ecstasy. And again, you just feel really connected to other people, you know, to the people you're with, to the other people on the dance floor. You know, usually you can kind of look and catch people's eyes and give each other this knowing smile and you know that they're on MDMA too. It's just a really beautiful feeling. And it allows me at least to be in the moment in a way that I'm not really often in the moment in my sober life. I'm not thinking about all the things I have to do or the things that went wrong today or whatever little neurotic worry I have in my mind at the moment is just completely erased. And I'm fully in the moment,

enjoying my friendship, my friend's company, enjoying the music, and just kind of being in a way that is elusive for me when I'm not on MDMA. So MDMA, it's also known as ecstasy, which you mentioned, or the love drug. It's now known for making people feel all the things that you described, so present and euphoric and connected to other people. But its origin story is pretty interesting, right? It was created by a German pharmaceutical company that was trying to develop a blood clotting agent. Exactly. So I think a lot of people think of MDMA as ecstasy parties, but the story really begins in 1912 when Merck, the German pharmaceutical company, filed a patent for MDMA. And as you

mentioned, they weren't actually looking for MDMA. They were looking for a blood clotting agent, and MDMA was just a chemical intermediary on the way to get to that. We don't know actually if Merck discovered the psychoactive properties of MDMA. There's some hints that perhaps they did over the next few decades, but they're really guarded about people getting into their archives and poking around for answers like that because I think they do want to, or have traditionally wanted to distance themselves from MDMA's psychoactive properties. And then there was a point in the 1970s where some therapists were giving MDMA to their patients in sessions, right? How did it make its way into therapist offices? Yeah, great question. So again, you know, we think of MDMA as this party drug, but

once its first popularization wasn't among recreational users, it was among therapists and their patients. So MDMA was re-synthesized in 1965 by a psychedelic chemist in the Bay Area named Alexander Shulgin. And he actually tried MDMA himself. And he compared it to a low calorie martini because he was still fully in control of himself. He could have a chat with his wife, his friends. But it didn't cause hallucinations or things that you think of traditional psychedelics or classic psychedelics like LSD doing. But what Shulgin did notice about MDMA was it opened up what he described as a window. He just felt like he could communicate with his wife, for example, without any fear or judgment of himself

and put aside whatever baggage they had from past issues and just be really honest with her. And he thought that this would make MDMA a really exceptional tool for psychotherapy in the same way that LSD had previously been used for therapy in the 1950s before it was banned. So he introduced MDMA to a therapist friend of his named Leo Zeff, also in the Bay Area. And Leo tried it, was really, really impressed and became sort of a Johnny Appleseed of MDMA in the therapeutic community, spreading it first to therapists in the Bay Area, then abroad to the US and Canada, and even to Europe. And MDMA became this really, really popular tool that therapists use as a sort of catalyst for enhancing whatever type of psychotherapy they were doing, whether it was couples counseling, whether it was treating trauma, or whether it

was just helping people get to know themselves a little bit better. But the thing is, they were keeping all this really quiet, because they knew that if the DEA here in the US caught wind of this, they would absolutely schedule MDMA, you know, take it off the shelf so that therapists can't use it so that research can't be done on it, just because this was the height of the war on drugs. And this is sort of like what the government did, you know, any new drug on the market, the knee jerk reaction was to schedule it. So these therapists were using it kind of quietly, despite it also not being approved by the FDA. Exactly. Yeah. Some therapists did publish some research on it, but nobody was doing clinical trials on it or anything like that. To your point about not having the FDA approval, the DEA's main argument in that

case was that MDMA can't have currently accepted medical use because it hasn't been approved by the FDA, which the judge was like, that's not a good argument. No, but again, they just did what they wanted and banned it. Yeah. And I want to come back to why the DA cracked down on MDMA in just a second. But while these therapists were experimenting with MDMA as a treatment for their patients in the late 1970s and early 80s, it also started making its way onto the club scene, right? How did that happen? Yeah, actually, that's a really great point you raise. So it's not like it was only being used by therapists at this time. I mean, for a few years, it was. The late 70s, it was pretty much confined to the therapeutic community. But as one therapist who was working with it back in those

days told me, it's a drug that makes you feel good. And any drug that makes you feel good, it's inevitably going to escape onto the recreational scene. And that it did. Some people began manufacturing MDMA not to sell to therapists, but to sell to club goers. And New York, San Francisco, and Dallas, Texas, of all places, emerged as sort of the center of MDMA club culture. of all places emerged as sort of the center of MDMA club culture. At the time, MDMA was still, when it was spreading on the club scene, it was still legal and it was really available everywhere, right? Like I was reading that there was a record store that sold it on the side and rang it up as accessories. It was being sold at spas and there were spas that were offering MDMA massages. And yes, you can find it at clubs and bars. Yeah, exactly. I mean, it was legal, so you could sell it wherever. And the examples you cite

all come from Dallas. There was a club at the time called the Stark Club that had just opened. And on opening night, someone had flown down from New York with a bag of MDMA pills and was like, flown down from New York with a bag of MDMA pills and was like, just hand these out. And it really made the Stark Club this incredible center of Dallas nightlife and also just sort of expanded the idea that people had of what a Southern city could be because you had people of all races, all genders, all backgrounds, you know, partying together and like hugging it out on the dance floor in a way that you just normally wouldn't in, you know, pretty conservative Texas. And yeah, MDMA spread all over town. Like you said, spas, pretty much all the clubs had it. You could buy it at the record store. It sounds like it was quite a scene. I wish I could travel back in time to see it for myself. So you mentioned some of the concerns around health and safety and MDMA that were really

being talked about at that time. I think I read it used to be known as a drug that would like eat holes in your brain, right? And this is still obviously a banned substance in both the US and Canada, except under limited circumstances, which we'll talk about in a bit. But what do we know at this point about the dangers of MDMA? Yeah. So in a therapeutic setting, you are taking a set amount of MDMA under guidance and you know what your drug is. So in therapy, as long as you're doing it in a legal sense, you are not going to face any serious negative side effects. There might be psychological difficulty, but that's related to your trauma,

not so much the MDMA. You're not going to overdose or something like that. However, in a recreational setting, the problem is that you don't know what you're getting. You have to buy your drugs illegally because again, MDMA is illegal. So you're buying it from whoever, maybe it's someone you know, maybe it's not. But regardless, you don't know what is in that pill or that powder or those crystals that you bought. It could be laced with meth, for example. It could be laced with bath salts, synthetic cathinones. You also don't know the purity of what you're getting. So you might get something that is like 60% pure and you're not feeling anything, so you take more. Or you might get something that's 60% pure and you're not feeling anything. So you take more or you might get

something that's 90% pure and then you accidentally take too much and overdose that way. So people have died from accidentally taking too much MDMA. People have also died from taking adulterated MDMA. If you do take the, let's say the correct dose of MDMA, and it is actually MDMA, the biggest risk is that you're going to overheat. This is mostly people who are, you know, dancing for hours at a time, not taking breaks, not hydrating, and then they develop hyperthermia as a result. So if you look at MDMA related deaths, overheating is the number one thing after, you know after adulterated pills and accidentally taking too much. Yeah. Do we know much about the health effects of regular long-term use, recreational use of MDMA? Ah, right. So I guess the question there is, does MDMA eat holes in your brain like

some of us were told in the 90s? Yeah, the answer is no. You're not going to develop holes in your brain. There is evidence that if you take MDMA at too high of doses, too no, you're not going to develop holes in your brain. There is evidence that if you take MDMA at too high of doses, you know, too frequently, we're talking about, it's subjective, everybody's different. But you know, if you're taking MDMA once a week, for example, for an extended period of time, you can have some negative side effects, like some memory problems, some people report anxiety and depression developing, but there's also evidence that once people just cut back, stop taking MDMA so much, those problems go away and any damage to their nerves that deal with serotonin, that's the main

problem that occurs, seem to resolve. At least that's what studies in animals suggest. So, I mean, all in all, MDMA, like any drug, like any substances, can be risky based on how you use it, but it's really not that risky of a drug when you look at the number of ER visits or the number of deaths that result compared to other substances, even legal substances like alcohol. I want to zoom out a little bit from just MDMA. In the last few years, we've heard the term psychedelic renaissance being thrown around quite a bit, maybe because of the research that's being done around the potential medical benefits of these drugs. But it also seems like culturally, there's something happening outside of labs as well. There's more interest in psychedelics among the general public, it feels like. Would you agree with that?

Yeah, 100%. I live in a little bubble. I'm in New York. A lot of my friends are drug users. So I have a slanted view of the general public in the US. That said, even in the time that I've been working on this book, so 2020 to today, things have changed so much. My mom, for example, and my dad are open to having conversations about psychedelics in a way that they definitely weren't just a few years ago. When I told my mom I decided to write a book about MDMA, her reaction was not very encouraging. She was just kind of like, oh, and not very encouraging. You know, she was just kind of like, oh, and sort of shut down, whereas now she seems really interested. She's asking all kind of questions. And I don't think that's just because, you know, her daughter happened to write

a book about MDMA. I think it's seeing, you know, headlines, so many news stories about psychedelics that are mostly piggybacking on that science that's kind of come in as what seems like a sudden wave, but really these studies have been in the works for literally decades, you know, trying to work through the bureaucracy and red tape of working with a strictly banned substance. So it's partly the science. I think also people are just really looking for answers and for help. You know, we're living in really tough times, like the climate change headlines and signs of that all around us are just, you can't ignore them anymore. The division politically, you know, in the US, for example, it's, you know, really, really shaken people up.

Also, mental health, you know, mental health is at an all time low, not just here in North America, but around the world. And people's faith in, you know, pharmaceuticals is a bandaid that's just gonna, you know, make their depression go away or make their life suddenly magically better, has waned and people are looking for answers for things that are going to bring them relief for their mental suffering, but also ways that we can perhaps reevaluate what we're doing as a society, as a species, you know, to try to get back to maybe the things that matter a little bit more, like connecting with each other and, you know, feeling less lonely and just feeling more together. In the Dragon's Den,

a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and

podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Cups. I've noticed the use of magic mushrooms recreationally becoming more mainstream. You know, unlike even a couple of years ago, it's not uncommon now to go to a party and people are microdosing mushrooms, maybe instead of drinking, and they're saying the kinds of things that you're saying. And there are all these stores that are popping up online, physical dispensaries popping up in places like Toronto, Montreal, I've heard New York, that are selling mushrooms pretty openly and advertising their mental health benefits. Do you think that is connected to the scientific

research being done on psilocybin and people hearing about it? Yeah, I think generally people are just getting maybe, well, some people are getting better at questioning just, you know, what we've been told our whole lives. You know, I was a dare kid, you know, taught like, you know, just say no to drugs, you know, drugs are bad, that kind of thing. And I, for, until I was in my 20s, I just took that for granted, you know, drugs are bad, that kind of thing. And I, for until I was in my 20s, I just took that for granted, you know, drugs are bad, don't do drugs. But I think people are opening up to being a little bit more critical thinkers about, yeah, just these lines we've been told our whole lives. And also, that relates back to alcohol, you know, I think people are becoming more aware of

the toxic effects that alcohol has and looking for other solutions that don't involve just, you know, getting wasted. I think Magic Mushrooms has stepped into that role for some people. Definitely weed has a lot. And the legalization of weed for recreation in a lot of states here has paved the way for, you know, people to be more open about mind-altering substances that aren't just alcohol. So just going back to MDMA then, we've gone from it being used in therapist's offices to becoming a party drug, to being banned, to kind of returning to its roots and re-emerging as a possible therapeutic drug. And like we mentioned, it's still illegal in the US and Canada. But what does the research tell us about the potential benefits of MDMA in a clinical setting?

So the research on MDMA-assisted therapy, so just to clarify for listeners, this isn't being given MDMA and going home and taking it like traditional pharmaceutical. This is taking MDMA in the presence of a therapist and going through a guided therapy session on MDMA. So the therapy is really integral here. Otherwise, you would see people coming out of raves, you know, with their trauma miraculously healed, which usually just does not happen. You need that guiding hand of a therapist and also that intentional setting of your own mind to engage with your trauma or engage with whatever it is that you're hoping to deal with under your MDMA assisted therapy session. that you're hoping to deal with under your MDMA-assisted therapy session.

So the research is furthest along for MDMA-assisted therapy for post-traumatic stress disorder, and it's really, really promising. There are indications from additional trials that MDMA-assisted therapy could be useful for a whole host of things. So there's evidence that it really helps to treat social anxiety in autistic adults, for example. There's also evidence that it helps for substance use disorders, for alcoholism. And people are beginning trials now to test things like depression, obesity, a whole host of things that could potentially be helped with MDMA-assisted therapy. How does MDMA work in these settings? And why is it seen as effective? Like what happens in the brain, if you could explain that? Yeah, this stuff is really fascinating. And the science on the mechanism of how MDMA-assisted

therapy actually works is pretty new. It hasn't been replicated by other labs besides the one that discovered it, which is really the gold standard for science. So we need those replicated results. We need more testing. But those caveats out of the way, neuroscientists are super excited about these findings and think that they really could finally explain what is happening in MDMA-assisted therapy and just psychedelic assisted therapy writ large. So there's a lab at Johns Hopkins run by a researcher named Gould Olin. And she's found that what happens under this therapeutic setting with MDMA is that the drug reopens what's called a critical period. Critical periods is just a term for neuroscientists use for these times of finite malleability when our brains are primed to learn new things. This usually happens in childhood. So

think of how easily a kid can learn a new language compared to we adults who just completely struggle to pick up a new language, most of us. So critical periods exist because there are more things out there in the world for us to learn than we could be possibly ever pre-programmed with at birth. And so what MDMA-assisted therapy does is reopens a critical period for what's called social reward learning, which is just the intrinsic reward that a social species like our own gets from being around each other. And it allows you under that context to go back into your memories of trauma and the habits you've formed around your trauma, the narrative you've told yourself about who you are as a result

of this trauma, and really reevaluate them and literally rewire neuronal connections that have formed around that trauma. So that is why it seems to be such a powerful tool. So we should mention that there have been some questions around the strength of the research, about the size of the trials, which some say are too small, as well as the way placebos are used, because it's easy for participants to know whether or not they've received the drug. That's just something to keep in mind. and there are a lot of examples in the book of people whose lives have been changed by these treatments i wonder if you can just maybe highlight one for us that really stuck with you maybe the most succinct story is that of a

gentleman in the UK named Dave. And Dave actually wasn't participating in the PTSD trials. He was participating in the trials for alcoholism. But like many people who have substance use disorders, his was driven by underlying trauma. So Dave had suffered from really crippling panic attacks since he was a late teen. It could be just the most mundane trigger that would just send him into an absolute panic. And over the years, he found that the only thing that could control this panic was alcohol. So he would just have a bottle of vodka with him at all times and reach for it and start chugging. And that over the years formed into a habit. He was drinking all day. It was disrupting his family life. He went into rehab for a while and he was trying also all kinds of treatments for this. He was seeing,

like he said, every therapist basically across the UK and none of them could really bring him lasting relief. Under the influence of MDMA-assisted therapy, Dave came to terms with the driver behind that alcoholism and behind those panic attacks, which was the fact that he had actually witnessed his mother's murder when he was a young boy. But this happened to Dave and he's one of these guys in the UK, they call them, they have a stiff upper lip, get on with it. Don't talk about your problems. Yeah. So, you know, he never talked about it.

He and his dad spoke about it like once when he was 30 years old. But under the influence of MDMA, he actually, you know, returned to that night in his mind and was able to just, you know, clearly see that this wasn't his fault. There was nothing he could have done, you know, as a young boy to save his mom. And ultimately, he was able to forgive the killer for what he had done to his mother. And also just come to terms with the fact that his amygdala, the part of his brain that is the fear center, had been calling the shots for his entire life. And he made up his mind under the MDMA, no more, you amygdala. And he's had really great results. He's able to function in his life, be a lot healthier, happier. And when he feels those panic attacks coming on, he can recognize

those triggers and do other things instead of reaching for that bottle of alcohol. triggers and do other things instead of reaching for that bottle of alcohol. So Rachel, Australia is now going to be prescribing MDMA and psilocybin to patients. The FDA could approve it any day now, like you said. In Canada, there's now a special access program to allow some people to access drugs like MDMA and psilocybin through their doctor's approval. And there's a lot more research happening around the world. We could see access to MDMA and psilocybin through their doctor's approval. And there's a lot more research happening around the world. We could see access to MDMA expanded pretty soon, right? What are you watching as these drugs become integrated into healthcare systems around the world? Oh, gosh, there's so many things and so many unknowns. I mean, the biggest thing is access,

making sure that insurance covers this and that there's means for everybody to get the help they need if they want it, and not just have these therapies confined to, you know, the very wealthy. Another issue is therapist training. So like I said, MDMA reopens this critical period, it returns your mind to this state of childlike vulnerability. So, you know, if you take MDMA with a therapist, and, you know, your therapist harms you, or, you know, they make a sexual pass at you, for example, or they're just not a very good therapist, there can be some real harm that results, you know, even worse than how you came into the therapy, that really sets you back. So I want to

make sure that there's, you know, solid therapist training and that there's also checks and balances. I do think that there's going to be a lot of disappointment. You know, there's been a ton of hype in the news about the potential for these therapies. And I think they are going to profoundly change many, many lives. But, you know, not every medical treatment works for everybody in the same way. And I think there are going to be a number of people who are really disappointed in the results or, you know, have okay results, but not like absolutely transforming results. So that's something that people should be prepared for. And I think we need more data on just to show like, who these therapies work best for under what circumstances, you know, who are the best candidates and how to maximize the potential success. Rachel, thank you so much for this

conversation. It was such a pleasure to talk to you. Thank you so much for having me and thank you for your interest. All right, that's all for today. I'm Tamara Kandaker. Thank you so much for listening, and I will talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.