It’s undeniable that drugs are becoming part of the mainstream. Our latest content series set about uncovering the most progressive and exciting emerging voices on the topic, sitting down with them to understand their perceptions and opinions of drug culture in Ireland, and the world today.
This is Truth on Drugs. Future thinking on drugs and society.
In 1976, a graduate student at San Francisco State University told her professor, Alexander Shulgin, that she and two close friends had conducted an experiment with a new drug. They had taken 100mg of 3,4-methylenedioxy-methamphetamine, more commonly known as MDMA, and reported that it had positive and “quite emotional” effects.
Shulgin was intrigued by the potential therapeutic benefits of the substance, introducing it to fellow researcher Leo Zeff and going on to conduct countless studies on the drug. Shulgin coined the name window, believing that it helped break down emotional walls and help users see the world clearly, while Zeff deemed the drug Adam, stating that it puts people into a state of “primordial innocence”. While this therapeutic research was ongoing in the late 70s and early 80s, the euphoric drug was also becoming commonplace on dancefloors in the USA and abroad. On 31 May 1985, in the midst of Nancy Reagan’s ‘Just Say No’ campaign, MDMA received emergency Schedule I classification and was listed as a banned substance in the USA, with countries across the globe eventually following suit.
“Lots of people feel very chatty and uninhibited on ecstasy, which makes them open up and talk about things they might not normally.”
When taken, MDMA increases the activity of the neurotransmitters serotonin, dopamine and noradrenaline in the brain. MDMA has stimulating, hallucinogenic, psychedelic and empathogenic effects, the latter meaning that it produces experiences of emotional connection and openness. UK drug advisory service FRANK lists MDMA as making most users feel “very happy, ‘loved up’, energised and alert [..] Lots of people feel very chatty and uninhibited on ecstasy, which makes them open up and talk about things they might not normally.”
According to Ireland’s National Drug and Alcohol Survey 2019-20, ecstasy is the second most commonly used illegal drug in Ireland and it’s estimated that 10.4 million European adults have tried MDMA during their lives.
A 2021 episode of The Guardian’s podcast, Today In Focus, examines the therapeutic possibilities of MDMA. It notes that drugs like MDMA can affect the plasticity of the brain, helping the user “open up and experience more of the world”, whilst also allowing them to look internally and examine deeper issues such as trauma. They speak to Dr Rachel Yehuda, the Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine. She says the drug could help trauma survivors see themselves with more compassion and understanding, as well as allow them to trust therapists—something that can be a big struggle.
Dr Paul Liknaitzky, Head of Clinical Psychedelic Research at Monash University, expresses similar thoughts in a 2022 episode of The Blindboy Podcast. He notes that psychedelics such as MDMA can “lower the defence barrier” and give access to deeper mental states. He notes that it’s crucial that MDMA therapy is used in the correct setting and recommends a calm environment and music to aid the process.
Founded in 1986, the Multidisciplinary Association For Psychedelic Studies (MAPS) is the world’s leading non-profit organisation specialising in research and education surrounding psychedelics and marijuana for mental health, well-being, and connection. Over the course of the past 35 years, MAPS has raised over $130 million for psychedelic research and education and have been conducting clinical trials in the space since 2004.
Betty Aldworth has been the Director of Communications at MAPS since 2020 and has led PR strategy for the organisation during MAP2, their second Phase 3 trial of MDMA-assisted therapy for PTSD. Over a Zoom call, she discussed the results of their clinical trials. “In the first phase of the trial, it was effective for 88% of participants in reducing their PTSD symptoms in a clinically significant way. For 67% of participants, they no longer qualify for a PTSD diagnosis at eight to 12 weeks after the end of the treatment period.”
Betty notes that the form of therapy MAPS is researching is unique in a number of ways. Individual MDMA therapy sessions can be up to eight hours long, and a 12 to 18 week protocol involves approximately 42 hours of therapy. On the length of the sessions, Betty explains that “anyone who has been in therapy knows the feeling of hearing: ‘well, time’s up.’ That’s a really big challenge for someone living with PTSD. Providing a container for that long session allows people to fully experience whatever is arising for them in that context can be really therapeutic in itself.”
During MAPS’ sessions, practitioners work from a number of modalities, making it a “highly individualised process”. Music can be used to help participants relax, while consensual touch, such as hand-holding, can be used at the discretion of the client. It’s important to note that, even under the influence of MDMA in a therapeutic setting, clients may still struggle to open up about their past traumas.
Betty explains “If a participant isn’t coming naturally on their own to any of the traumatic events that might have happened to bring them to the study, then the practitioners are encouraged to ask gentle questions about the traumas that the person would have shared in the preparatory sessions, so they can gently introduce that into the session.”
“The idea is that, through this therapy, people are able to really start to understand that they have the capacity to change the way that they interact with their trauma.”
Research into MDMA-assisted therapy is still in early stages, with the majority of trials conducted in the United States. The idea of the drug being approved for use in a therapeutic setting, particularly in Ireland, still feels a long way away. However, Ravind Jeawon, a psychotherapist at Talk Therapy Dublin, has noticed an increase in clients expressing interest in alternative forms of trauma therapy.
Ravind explains how some clients have either used or researched drugs in their own lives, “and inquired with a therapist such as myself about whether it was possible and whether there was a way of integrating it into their healing process.”
With Ireland currently having one of the highest rates of mental health illness in Europe, and mental health care services suffering from underfunding and a lack of resources, it is unsurprising that people are not satisfied with the limited forms of treatment available. Ravind states that an issue with mental health care in Ireland is the lack of accessibility. Those with the financial means can access support faster, while people looking for affordable options are stuck on long waiting lists. When he was newly qualified, he noticed that it was difficult to access specific therapies, such as EMDR, a well-known treatment for PTSD. He notes that the most common form of therapy offered in Ireland is CBT, or cognitive behavioural therapy.
“CBT is wonderful and can be very effective for specific things like phobias and panic attacks. Doctors and medical professionals love it because there is a huge amount of research gone into it. And, because it’s manualised, it is easier to track progress over other types of therapies. Yet, we do get some clients saying it didn’t work for them. There is a lot of status quo and money invested in CBT. So, if it’s more expensive to deliver MDMA-assisted therapy versus CBT, who’s going to get the government funding? It becomes tricky then.”
In 2021, Ravind made a blog post on Talk Therapy Dublin’s website acknowledging the number of inquiries he had received about MDMA-assisted therapy. The queries began after he shared an article about the promising results of a MAPS clinical trial, and he was surprised at the level of interest it amassed. The blog post stresses that MDMA-assisted therapy is not currently available as a treatment in Ireland, noting that, as well as needing more research, it also would require specialist training of therapists to deliver this form of treatment. However, increased conversations around the potential of these drugs show that the demand is there.
“If clients are already looking for it, that says everything,” says Ravind. “These trends start and gain credibility in the US, but it often takes a lot of time and money for them to trickle down to Ireland.” Ravind hopes that the future will involve more curiosity, research, and open conversation about the different types of therapies available for clients.
“Let’s be honest here: we [psychotherapists] are working with people on meds all the time. How many of my clients this week are on antidepressants, anti-anxiety or sleeping tablets or antipsychotic medication? We are already doing drug-assisted research. Now, we’re not prescribing it—the doctors are— but we are working with people under the influence of psychiatric drugs because they’ve been deemed effective. Medical professionals work in multidisciplinary teams to collaborate and prescribe drugs. Why do the words ketamine, MDMA, or cannabis make everyone scream, calling it madness, or unethical?” Ravind continues.
There are a number of barriers that must be overcome before MDMA-assisted therapy becomes an option in Ireland. There is a need for more research to be conducted to get a clearer understanding of the therapy, its possibilities, and the potential risks. Then there is the financial aspect—as Ravind highlighted, it will be costly to conduct this research and train practitioners. As with all experimental medical developments, it is likely that this treatment will be expensive and difficult to access if, or when, it does reach the market. Alongside these factors is the wider issue of societal perceptions around recreational drug use that must first be challenged.
Betty Aldworth sufficiently sums up these long-held biases against recreational drugs and the need to break the stigma before we can move forward as a society.
“Every documented human in civilisation has had access to mind-altering substances. Potentially everyone—except those in the Arctic Circles—has sought to alter their minds. Two-year-olds spin in circles to alter their minds and fall down and feel dizzy. It is the most human thing in the world. And so, if you recognise that, and stop punishing people for that behaviour, and instead put some guardrails around it and some education around it, then I think that we can really start to address some issues that have threads that run all throughout society.”
Follow Kerry at @kerrywho
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