Australia Leads Psychedelic Therapy Revolution with First MDMA Prescription

 

This week was another win for the psychedelic ream when the Australian psychiatrist and co-founder of Monarch Mental Health Group (MMHG), Ted Cassidy, prescribed the first MDMA prescription to a female patient suffering chronic, treatment-resistant post-traumatic stress disorder.

Dr. Cassidy claims that one day, using MDMA-assisted therapy, achieved more than one year of traditional therapy.

The doctor and his team had to travel to Melbourne to prescribe the substance due to restrictive rules in New South Wales.

Now, Dr. Cassidy is asking for changes in the regulations so the next patient doesn’t have to travel to get the needed treatment.

The news was shared via LinkedIn, with the shared groundbreaking announcement, followed by the historic picture of the prescription.

“It is a career highlight for me, the very first regular normal script that any doctor has written for a psychedelic medicine in the world.

Today’s treatment is the world’s first psychedelic-assisted therapy (PAT) treatment ever given outside of research and compassionate use protocols [and] is built on a history of psychedelic practice back to the dawn of civilization and across all indigenous cultures.

I am proud to have been part of the team at Monarch that has made this the first clinical Psychedelic program available to patients in the world. I am proud that Australia has taken world leadership in translating psychedelic research into clinical reality.” – Dr. Ted Cassidy.

 

 

How does MDMA help treat mental illness? 

We’ve all heard of MDMA as being a party drug under the name of Ecstasy or, by its media entitlement, “Love Drug.”

Psychologically speaking, after the intake of the substance, the patients often feel more open to talking about their feelings or previous trauma, making it easier for the psychiatrist be able to understand and find a solution for the patient’s issues.

MDMA mainly acts as a releaser of serotonin and noradrenaline. And, to a lesser extent, dopamine. Most of the effects of MDMA are caused by the activation of the 5-HT system,

The activity in the 5-HT1A and 5-HT1B receptors attenuates the feelings of depression and anxiety,  reduces the amygdala fear response, and increases self-confidence, feelings of closeness, greater compassion, and increased empathy for oneself and others.

Whereas dopamine and noradrenaline raise levels of arousal and awareness, allowing patients to be more engaged in therapy and promoting fear extinction.

Additionally, MDMA affects alpha-2 receptors, which contributes to the drug’s effect on thermoregulation, which may contribute to a paradoxical relaxation/ sedation effect. Such effects can be beneficial in the context of trauma-induced hypervigilance. Contrary to alpha-1 receptors, alpha-2 receptors don’t appear to be critically involved in the psychological effects of MDMA in humans.

The compound has been shown to facilitate the release of oxytocin, the hormone associated with early infantile bonding, thus allowing patients to increase levels of empathy and closeness, dampen fear-related amygdala activity, and decrease stress response and social anxiety, hence, its nickname “Love-drug.”

 

What to expect in MDMA psychotherapy?

The sessions borrow much of their methodology from the earliest research of psychedelic therapy in the 1960s and 1970s, centralizing the concepts of set and setting. Set refers to the user’s mindset and setting to the environment where the drug is taken to provide optimum psycho-environmental conditions for the patient’s experience.

Therapeutic sessions are non-directive, encouraging the patient to go with the experience. The therapist creates a sense of safety and communicates trust in the patient’s ability to explore their issues.

Often, staff will provide eyeshades and headphones to isolate the experience or put you at ease. Having your blood pressure and temperature measured is also usual.

 

 

 

 

A brief history of MDMA psychotherapy:

Despite MDMA only being first prescribed this week, there was an extensive history of MDMA psychotherapy during the 1970s.

First rediscovered by Alexander ‘Sasha’ Shulgin when studying derivatives of the essential oils of nutmeg, the compound impacted psychotherapy when Shulgin introduced the compound to psychologist Leo Zeff in 1977.

Zeff administered the substance during the next twelve years of his career to about 4000 people and trained more than 150 therapists. (https://maps.org/images/pdf/scr.pdf)

During the Association for the Responsible Use of Psychedelic Agents (ARUPA)  meeting in the early to mid-1980s, MDMA became a major topic amongst the participants were most of the psychedelic luminaries at the time, David Nichols, Rick Doblin, Jack Downing, Stan Grof, Oscar Janiger, Rick Ingrasci, Sasha Shulgin, Myron Stolaroff, Rick Strassman, Ralph Metzner, Leo Zeff, and George Greer. 

In March 1985, it became obvious that the scheduling of MDMA was inevitable, as the substance had become popularized outside the clinical realm and became a party drug. Thus, another conference was held under the name “MDMA in Psychotherapy” at Esalen. The conference held 36 participants, among them Stanislav Grof,  Claudio Naranjo, Yensen, Lynch, and DiLeo, as well as the psychotherapists using MDMA in their practices (Greer, Downing, Wolfson, Ingrasci). At the conference, it was reported that MDMA reduced defensiveness and fear of emotional injury, allowing a more direct expression of feelings and opinions and enabling people to receive both praise and criticism with more acceptance than usual.

 

Ann Shulgin’s experience on working with MDMA:

In the 80’s, Ann Shulgin began to help friends sort out personal problems with MDMA sessions. In these sessions, Ann would take the substance together with the patients. However, she recognized that it was counterproductive.

Ann was being instructed by Leo Zeff and partnered with a licensed therapist. The therapist would refer patients who had been in therapy for at least six months. 

At the start of these sessions, patients had to consent to four agreements:  

• • No expression of hostile feelings in aggressive action.

• • No sexual activity

• • No allowing the consciousness to abandon the body in a manner that would cause physical death

• • No exiting until the end of the session 

The therapist’s actions and attitudes would be directed toward activating the patient’s own healing abilities. For this reason, one crucial prerequisite would be to care and create a trustful relationship in a therapeutic dyad. 

As for dosages, there would be the usual dosage of 125mg orally, sometimes followed by 40 mg, 90 minutes later. 

“One of the problems that most humans beings suffer from is the suspicion that the core essence of who they are deep down is a monster. There is terrible fear . . . when you get down to it. . . . MDMA removes that fear. . . . During psychedelic therapy, . . . what we do is we go into it and look through its eyes, so that we become it. But we’re all afraid that we got stuck with the demon. . . . Once you get inside the demon, the first thing you experience is a lack of fear, and then you begin to recognize that this is also the survivor aspect of yourself. There’s a part that takes care of you. Then it begins to transform, and you recognize its quality of total selfishness—it’s going to take care of you and nobody else, right? —but it’s your ally. And then you begin to recognize its positive aspects.”

– Ann Shulgin

Ann’s active therapeutic work spans over a few years, but she influenced various other psychotherapists and authored an early guideline for the therapeutic use of MDMA. She also mentioned the therapeutic synergy of MDMA with 2-CB for the first time. As expected with the works of the Shulgins, Ann not only kept track of success stories but also covered a few cases in which MDMA did not help her patients

 

 

 

Other MDMA psychotherapy mentions:

 

Kueny’s 1980 study

In 1979, Alexander Shulgin initiated an exploratory study about the psychotherapeutic use of MDMA at the Pacific Graduate School of Psychology in San Francisco, California. The psychologist Sallie Kuent administered MDMA to nine patients in a nonclinical setting to evaluate the use of the compound in psychotherapy and understand the connection between patient and therapist post-intake of the substance.

No negative effects were registered during and after the sessions. All subjects reported positive experiences free of usual anxieties.

“This brief experiment yields enough provocative data to justify further research on that issue. . . . MDMA allows ordinary defenses against communication and closeness to relax, and permits those involved in its effects to deal with substantive issues. . . . The implications for using this agent in the therapeutic setting are enormous. “

-Sallie Kueny

Originally, Kueny planned to administer MDMA on three occasions to each client. However, the project was stopped for technical reasons after each client had one session.

 

Claudio Naranjo’s early research in drug-assisted psychotherapy.

In the late 1970s, Naranjo was a predominant figure in the spiritual teaching programs in California and became the most scientifically educated among the early MDMA therapists.

By 1984, he had used MDMA with more than 30 PATIENTS. Naranjo preferred using MDMA over MDA, as MDMA was non-hallucinogenic, less toxic and had mild side effects. 

In his clinical practice, he used the substance once or twice per patient in therapeutic settings. 

“I mostly use MDMA as an ‘opener’ at some point in psychotherapy, not only for the wealth of the material gained during the session but for how it facilitates therapeutic work in the aftermath.” 

-Claudio Naranjo

Usually, he worked with groups of 12 to 16 people and conducted individual interviews with those group members. 

The first group session was devoted to personal information, sharing expressions of interpersonal emotions, and clarifying expectations. 

There were three specific rules that patients would have to follow: 

• • Seek a balance between spontaneity and noninterference.

• • Abstain from sex during the session and the night after.

• • Wait for the effects of MDMA in an attitude of self-observation and goal-less restful effortlessness, and do not seek contact with other members before devoting sufficient time for self-immersion.

After the therapy, an integration session would be conducted for the group to share experiences, feedback, and therapeutic intervention. 

Not much is known about the continuity of Naranjo’s work with MDMA during the 80s and 90s, but he was involved in the training of a Spanish team to study MDMA- assisted therapy for victims of rape and violence. 

 

 

 

Ralph Metzner in MDMA psychotherapy

Ralph Metzner met Leo Zeff at an ARUPA meeting. Zeff guided him in some MDMA sessions. Zeff used a permissive approach with minimal therapeutic intervention, whereas Metzner preferred to be more directive.

During 1983-1985, Metzner became an expert in MDMA-assisted psychotherapy. He published a collection of first-hand descriptions of MDMA psychotherapy and spiritual exploration with the psychologist Padma Catell.

 

 

 

Joseph Downing and Exuma Island Institute

Downing started using MDMA in psychotherapy around 1984 in 8 patients. 

He describes MDMA effects as much different from classical psychedelics. 

“The site of action is primarily in heart and emotions… It produces no images or hallucinations. It does produce a general sense of well-being…Feelings of fear and anxiety lift. One feels that one can examine both one’s motives and actions, and those of others, calmly and objectively, with acceptance and compassion… Depending on the material contained in the unconscious, the patient will deal with any situation, from childhood traumas to long-felt adult insecurities, to deeply repressed emotions.”

-Joseph Downing

 

Downing reported a case of a patient who was a victim of crime. The patient was abducted, tied up, and tortured for several hours. 

After therapy, she still suffered from terrible flashbacks, nightmares, and suicidal thoughts. These were the notes taken by the patient. 

“I’ve taken it several times, and each time I felt a little less fearful. For the first time, I was able to face the experience, go back, and piece together what had happened. By facing it, instead of always burying it, I was able to sort of slowly discharge a lot of horror. The drug helped me regain some measure of serenity and peace of mind and enabled me to begin living a more normal life again.“

-Tamm (Patient)

 

George Greer’s work with MDMA

Zeff taught Greer about MDMA and gave him some training sessions. After some evaluations, Greer noticed the potential of MDMA’s therapeutic value.

Consequently, he synthesized 8g in Shulgin’s lab and started to work with it in his office.

During 1980 and 1985, Greer worked with his wife, Requa Tolbert, and treated over 8- patients with MDMA- assisted psychotherapy.

 

MDMA in couples and patients with life-threatening illness Rick Ingrasci

Rick Ingrasci became enthusiastic about MDMA in the late 70s. After integrating the substance into his treatment sessions, he became convinced about the therapeutic potential of the compound.

Ingrasci treated about 100 patients in about 150 sessions in a five-year gap. 1/3 of the sessions were with couples.

It puts a person in an unbelievable open frame of mind… the expanded capacity for self-awareness, the expanded sensitivity, the increased ability to share feelings. All that’s attributable…to the lowered fear and anxiety induced by this drug.

In couples therapy, MDMA worked as a catalyst for dissolving encrusted communication blocks.

To sit with a couple…as they kind of opened up and you facilitate the process a bit, but, quite frankly, once things get rolling, it’s like, they just kind of go where they need to go… What [MDMA] does is, actually remove the fear of being real, of being authentic with yourself and with other people. . . . Afterwards . . . you don’t need to take MDMA in order to experience authenticity.

-Rick Ingrasci

 

Therapy of patients with psychotic crisis and their families- Phil Wolfson

Phil Wolfson was the only physician using MDMA with patients experiencing psychotic crisis and their families. 

Wolfson’s most noticeable example was a case of a 27-year-old male with a psychotic illness that had begun two years earlier. 

His psychosis was characterized by hallucinations, paranoia, delusions, and negativism. After being hospitalized several times, the patient underwent various MDMA sessions with different configurations. 

“The first MDMA session…was profound in the change in this individual’s sense of self. Connections of an affectional nature were made with his parents and myself and the openings of trust experience began. For the first time in two years, he experienced a glimpse of a positive self-image and loving feelings that did not panic him. The afterglow of this session lasted several days with intensity, but recognition of that positive self-image has lasted permanently. “

-Wolfson report on the patient

 

 

 

 

Earth Metabolic Design Laboratories (EMDL)

The Earth Metabolic Design Laboratories was set in 1984 to support and coordinate the opposition against the scheduling of MDMA. 

The organization was directed by Rick Doblin, Alise Agar, and Deborah Harlow, and the board advisors included James Bakalar, Francesco Di Leo, Jack Downing, George Greer, Stanislav Grof, Stanley Krippner, Richard Price, Tom Roberts, Alexander und Ann Shulgin, Richard Yensen, and Leo Zeff.

EMDL is set to fund six human studies with MDMA. These studies included an investigation of the routes of metabolism and physiological effects of MDMA in humans, a survey of physicians and therapists who had administered MDMA in their therapies, a pilot study to evaluate the use of MDMA as a training tool for the education of mental health professionals, a study designed to evaluate the use of MDMA in the treatment of psychological distress in cancer patients, an evaluation of the effects of MDMA in a double-blind study and an investigation of the effects of MDMA on insight and empathy within psychotherapeutic context. 

The organization dissolved in 1986, shortly after the ban on MDMA. Following this event, Rick Doblin founded the Multidisciplinary Association for Psychedelic Studies (MAPS) to gather funding for clinical studies involving MDMA.

Recently, MAPS rebranded its public benefit corporation to Lykos Therapeutics and is slated to bring us pharmaceutical MDMA this year! 

 

MDMA therapy goes underground

At the beginning of the 70s, some therapists went to Europe to continue their work with MDMA. Ann Shulgin continued to be a center of an international network of psychedelic therapists by her husband, Alexander Shulgin, who claimed that there were some psychotherapists and psychologists who used MDMA in the seventies, and when the compound became illegal, its use went underground in both Europe and USA. 

These claims were then backed up by one of the books of the British MDMA researcher Nicholas Saunders, who interviewed some underground therapists. 

One of them was a psychotherapist under the pseudonym Andrew, who got to know Zeff and MDMA in the late 70s and hosted his first MDMA group session in 1980. Andrew had a network of therapists in Europe interested in learning how to conduct therapeutic MDMA sessions. Andrew and his associates conducted these therapies in Germany, Austria, Switzerland, the Netherlands, Hungary, and Czechoslovakia.

“We started gradually in 1981. By the next year, it really got going… We sat for about twenty groups of twenty people per year… Psychologists from different cities became interested in starting their own groups.”

-Andrew

In early 1985, George Greer published his booklet “MDMA Users Manual.” which gave instructions and precautions on its use.

In mid-1985, MDMA was still legal in Europe and held a major conference with more than 500 participants in Todtmoos, Germany. After the event, MDMA became known to a larger public, igniting a further interest amongst German therapists and inspiring them to work with MDMA again, as it was much easier to manage clinically than LSD. 

One year later, some of those therapists founded the legendary entities.

• • European College for the Study of Consciousness (ECSC), led by Professor Hanscarl Leuner and Albert Hofmann, ECSC was broadly known to bring together scientists interested in psychedelic therapy and altered states of consciousness.

• • Swiss Physicians Society for Psycholytic Therapy, with five of their members having permission to use MDMA and LSD in psychotherapy during 1988- 1993.

Eventually, MDMA started being used in the context of the rave dance movement and as a party drug, consequently making the substance illegal.

Having a certain number of how many MDMA underground therapies were done is impossible. However, plenty of underground MDMA therapies have likely been around until today, and plenty of patients have benefited from the compound.