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3,4 methylenedioxymethamphetamine, known colloquially as ecstasy, or molly (which is slang for ‘molecular’), is a man made psychoactive drug which is derived from the safrole oil, found primarily in sassafras plants. MDMA has properties of both hallucinogens and stimulants, acting primarily through its interaction with serotonin receptors. It forces the brain to released large amounts of the neurotransmitter, while blocking its reuptake to aid in extra absorption. MDMA comes as either pressed pills, or as a powder that can range from brown to white.

MDMA is known for promoting a feeling of connectedness between people, of reducing fear and anxiety, and increasing feelings of empathy. It was created by Merck Pharmaceutical back in 1912, however its effects were not well understood until the 1970’s when chemist Alexander Shulgin created a new method to synthesize the drug, and tested it out along with a few of his psychotherapist friends. This is around when it started being used in psychotherapy practices, as a treatment method coupled with therapy sessions, known as psychedelic-assisted therapy.

Despite showing usefulness in dealing with mental disorders, MDMA was illegalized in 1985. In 1984, President Ronald Reagan’s administration enacted the Comprehensive Crime Control Act which allowed for emergency banning of drugs by the government. When the subject of MDMA came up in 1985, after other psychedelic drugs had already been illegalized, this act was used to immediately illegalize the compound by placing it in Schedule I of the Convention on Psychotropic Substances treaty, ending therapeutic uses of it.

The illegalization of psychedelics started with smear campaigns during the Vietnam war which culminated in the passage of the Staggers-Dodd bill in 1968illegalizing LSD and psilocybin specifically. This was followed up with the creation of the Convention on Psychotropic Substances treaty in 1971 which outlawed most of the rest, with the exception of MDMA, which was outlawed later.

While the topic is obviously a controversial one, statements made by John Ehrlichman – former Assistant to the President for Domestic Affairs under President Nixon in 1994, made evident that the war on drugs wasn’t necessarily about drugs at all. Creating further concerns about why drugs like MDMA were illegalized. In his statement he claimed:

So, what do we really know about the ability of MDMA to treat PTSD symptoms? In 2020, a systematic review was released that investigated articles published up until the end of March 2019, that used key terms like ‘treatments for PTSD’ and ‘MDMA pathway’. All articles came through PubMed and ScienceDirect.

It was found in the identification and review of these articles (and their sources) that many small scale investigations had been done that show MDMA aids in reducing psychological trauma. The review authors made a very important point, though. They emphasized that none of the research showed MDMA as a cure for PTSD, as that specifically had not been researched.  What the review was identifying, and what had been studied, was the usefulness of MDMA assisted psychotherapy, and its ability to help people who have been unable to resolve their trauma issues through other avenues.

The big story today with MDMA revolves around currently in-progress trials. As of last summer, the Multidisciplinary Association for Psychedelic Studies (MAPS) had begun Phase 3 of clinical trials into MDMA. MAPS is conducting double-blind, placebo-controlled, randomized trials at multiple sites, testing the safety and efficacy of MDMA-assisted therapy for PTSD. The participants are 200-300 PTSD sufferers who are all 18+ in age, but with varied histories to produce their traumatic experiences.

These trials follow the Phase II trials which had promising outcomes, and are the last hurdle required by the US Food & Drug Administration (FDA) in order to be assessed for legalization in the treatment of PTSD. Should it get the pass, MDMA would be able to be prescribed along with therapy, in outpatient settings with residential stays – to allow users to have their experience in a safe and controlled environment.

How likely is the FDA to approve MDMA to treat PTSD? It is, after all, a psychedelic drug in Schedule I, which defines it as highly dangerous with no therapeutic value. Apparently, back in 2017, the FDA identified MDMA as a ‘breakthrough therapy’ for PTSD.