Interview by Mary Ought Six
HIGH TIMES: In regards to MDMA research, why do you think that you have had success working within the system? Have you ever had a negative reaction from the DEA or ONDCP to MAPS or your research?
RICK DOBLIN: Well I practically have had nothing but negative reactions from the DEA and ONDCP. They definitely don’t like what we’re doing; they are destructionistic and in many cases need to be sued to do what’s right. The drug Czar’s office is really based on ideology, they actively suppress science that they fear might turn out against their propaganda, the DEA is really willing to ignore human suffering in order to delay research that gets in the way of any kind of arguments about the value of prohibition. I think what has happened though, is that we’ve had success despite the DEA and the ONDCP, primarily because of persistent, political pressure on the DEA and on the drug Czar’s office, and because there really are parts of our government left that put science before propaganda. And that’s the FDA. The FDA is really the main agency at this point that can be relied on. Even though President Bush has succeeded in politicizing the FDA now. In terms of Plan B, the morning after pill, the advisory, the staff, are refusing to make a prescription medicine. The woman who was in charge of women’s health resigned last week from the FDA in protest against this. So, it has not yet extended to marijuana or psychedelic research, but there was a period of around twenty years, the middle sixties into the nineties, where it was impossible to get permission on research with psychedelics and nearly impossible for medical marijuana.
HT: Is the medical MDMA one of the only psychedelic studies that the FDA has approved?
RD: No, the FDA is primarily focused on science to help human suffering. So the FDA has approved a whole series of studies. They’ve approved psilocybin for the treatment of Obsessive Compulsive Disorder, [and for the treatment of] anxiety associated with terminal illness, they’ve approved a study with mescaline to see what it does to brain function, they’ve approved studies with Ibogaine, which is used in the treatment of addiction, they’ve approved multiple studies with marijuana for a variety of illnesses, they’ve approved MDMA for Post Traumatic Stress Disorder, they’ve approved MDMA for anxiety associated with advanced stage cancer, they’ve approved DMT research… So the FDA is really willing to approve studies. To give you an example though, we had FDA approval and the Institutional Ethics Committee approval in December of 2004 for a study to help people who are dying with anxiety. We still don’t have DEA approval. We’re working on it, we hope that we will get it soon, we hope probably within the next two months, but we don’t have it yet, so. You know the DEA had to be pressured by somebody from the senate to give approval for the MDMA Post Traumatic Stress Disorder (PTSD) study. So I think the reason that we’ve had success is that we care about starting it more than the DEA cares about stopping it. We just keep trying and they keep blocking us. It’s like water going down a hill, it hits a rock and it goes around the rock. It hits a log and it goes around the log. Eventually things are with us because people do want to see treatments for people facing terminal illness, people facing PTSD, most of the people in America are for the use of medical marijuana.
HT: How does the research that you are doing with medical MDMA differ from the research that they do with conventional pharmaceuticals that are available to the public?
RD: That’s a very good question. Two drugs are approved by the DEA, Zoloft and Paxil, for Post Traumatic Stress Disorder. Those are drugs that you have to take every day for months and sometimes when you stop taking them you’re fine, you’ve gotten over the problem, but quite frequently you stop taking them and the problems come back because they were never used to try to get at the core of the problem. MDMA in contrast is only used a few times to help people get deep into their trauma to work through it. Except it, understand it, work through it. Figure out how to live with the awareness that that happened and not burdened by the thought that it is always going to keep happening. And from what I’ve just told you, you can understand that psychedelics are not big money makers. The drugs themselves are only given a few times. In the longer process it is non-drug psychotherapy, so the pharmaceutical companies are not interested. They’d rather sell you a drug that you have to take every day. That once you stop taking it your problems come back and you need to go back on the drug. With MDMA our goal is, I mean it doesn’t work with everybody, but our goal is that you take it a few times with a longer process of non-drug psychotherapy and then you don’t need the drugs anymore. So we’re trying to make people independent of drugs, and to learn from the drug experience and feel better because of it. But feeling better, I mean people have the wrong idea, Ecstasy, they think you take the pill and your problems go away no matter what they are. Actually it’s the opposite, if you take Ecstasy, if you take MDMA, it takes you into your problems so you can see them, work through them, people cry, people are fearful, people have difficult times. But it’s difficult in a productive, healthy, healing way. So I think that is the big distinction, we’re really trying to help people become more healthy drug free and the pharmaceutical companies have drugs that you have to take every day for a really long time.
HT: So it is possible for someone to have a “bad trip” while taking MDMA in a clinical setting?
RD: What we need to do is make a distinction between bad and difficult. We expect that people are going to have a difficult experience, you know people have been raped, people have been in a war, people have had very traumatic difficult experiences, and they are burdened by them and they can never go away, and they wake up with nightmares, and they avoid dark alleys or they avoid going out to their car because of car accidents, you know people are burdened by their experiences. And so the thought is that they take MDMA to help them work through it. Another example is, when you think about people having a bad trip, it’s because it’s difficult, it’s frightening, and they can’t work through it. They get stuck in there and it feels horrible. But in a safe environment you’re going to break down, you’re going to cry, to let out the feelings.
HT: So how would a therapist handle that type of situation?
RD: Well, we have what’s called the treatment manual that describes the treatment we are doing on the website. (www.maps.org) But to more answer you’re question right now, really support people, you make them feel safe so that they can look at what scared them, what happened, and try to come to terms with it. MDMA focuses people’s attention on the present moment, and so it makes it clear that the trauma that happened in the past was in the past and that moment has passed, and that it doesn’t have to keep happening over and over and over and it’s not happening now so that you learn from past. You need to learn to protect yourself, to learn who to protect yourself from, what situation to protect yourself from. Catharsis is the word. It’s like when somebody you love dies. A lot of times people have a hard time grieving, but if you grieve for somebody the pain doesn’t go away, they don’t come back to life, but you’ve encountered reality in a way, and then you can move on. It’s difficult, but it doesn’t have to define your life, I think that’s the distinction that people realize that they can create anew, who they are, what they’re going to do, where they’re going to do it, who they’re going to do it with. So that when you have a patient under the influence of MDMA you can actually help them to feel more pain, feel more fear, feel more of the difficult thing that they have not fully felt, that they have defended themselves against, because they haven’t fully felt it, it just sort of sticks around. It’s like something that needs to be acknowledged, once it’s acknowledged you sort of incorporate it into the larger sense of who you are, you’ve grown, and now you can move on. So it’s definitely difficult, MDMA doesn’t make it less difficult, in a way it helps you to make it more difficult, but it’s difficult in a productive way.
HT: What kind of specific training do therapists have prior to conducting these types of sessions?
RD: Well, that’s a whole other issue, because the kind of training that we would ideally like is currently illegal, where therapists would get their own experiences with MDMA, so they understand subjectively what it does and at the same time as they do that they also get training on understanding of the mind and the realms of the mind, the realms of experience that people can have within MDMA and other psychedelics. So, for example, we went to Burning Man, MAPS provided help with the rangers there and provided psychedelic emergency services for people who had difficult trips there at Burning Man. And that’s in a way where we get training. You know, a steady flow of people who are having difficult trips. We have therapists from different universities and different places working together to watch to see how each other work and they get to offer feedback to each other. So the kind of training would be more humanistic or trans-personal psychology. The sort of branch of psychology that I think would be the most appropriate for this kind of work.
HT: What was the history of MDMA psychiatric research before it was made illegal?
RD: Well there really wasn’t much research before it was made illegal into therapy, but there were about a half a million doses of MDMA taken in sort of personal growth therapy context from the middle 70s to 85 when it was made illegal. And, research was purposely not done for fear if it was made public that it would notify the authorities that something was going on and then they would just criminalize MDMA. Because from the middle 70s to the middle 80s, that was during this period where the FDA wasn’t permitting any research and at the same time the drug war was ramping up, so anything that was similar to a psychedelic that was already illegal would automatically be made illegal. So, there was a lot of therapy going on, but no formal research. I learned about MDMA in 1982, and already it was being talked about as Ecstasy as well as MDMA. The code term for it in the therapy community was Adam. It was clear that it would eventually be made illegal, that it was just too good to be true, to last, too good to last. That society was still wrapped up in prohibition mindset. So we did one study in 1984 with about 30 people, it was a safety study. But we kept the results secret pending when the government would act against it. And so, in the late summer of 84, the government announced that it was going to try to make MDMA illegal and then I went to Washington DC to file the proper paperwork to say no, we want a hearing on it. Then the hearing was granted and took place in 85 and that’s when we took out our safety study and presented it as evidence to the administrative judge of the DEA.
HT: Have there been any long term side effects that have shown up from the early testing?
RD: Well I would say that that is quite a debatable question. When MDMA is used in therapy relatively few times, where people are sort of lying down, not dancing, it’s pretty clear that there are no significant long term consequences. There are major positive benefits from a therapy setting, and it’s very rare that somebody would feel like with MDMA that they opened up emotions they weren’t really ready for, and they were stuck and that they didn’t really resolve. It’s more true of psychedelics like LSD, mescaline, psilocybin, less so of MDMA. In terms of this whole brain damage question, it was so vastly over hyped. There is very little evidence that MDMA causes any serious significant brain damage, even for heavy heavy users. There are some studies that claim there are some effects on memory. There’s some studies that claim there is an effect on mood, but there is a lot of methodological problems with these studies and so it’s pretty clear that MDMA does not hurt your body, does not cause liver damage, doesn’t really significantly hurt your body. For moderate users who’ve taken it 50 times or less, research usually shows that there is no effect on the memory or anything like that. For people who have taken it more often than that some studies show some mild effects, nothing all that to be that worried about.
HT: What about serotonin suppression?
RD: Well, that’s what I’m saying. There is a whole lot of exaggeration going along with that. The dose that was shown to cause serotonin suppression in animals was not the same doses that people take.
HT: Where do you see the line being drawn between medical and recreational use?
RD: Well that’s a very good question. Well I think that in our culture, that medical usage is specific mental illnesses or physical illnesses that the medical community agrees on. So depression, anxiety, treating those kinds of things you consider to be medical; however, a lot of people feel that recreational is, well, for example: A lot of people like to go out and dance, you know, without drugs, and dancing is exercise, [it is] social, people feel better and people even talk about exercise as being preventative. So in a sense a lot of recreational stuff, de-stressing, relaxing, you can really consider a lot of it to be preventative. So where you draw the line… Our culture tends to say recreational is frivolous; it’s escapist, kinda like a lot of stupid movies that of course our society accepts. Medical is treating serious illness that insurance companies will pay for you to get treated for. So, what do I do with my life, a twenty year old in college is wondering what to do with her life, you know that’s not a disease, but at the same time psychedelic psychotherapy can be very helpful for that person. I think that recreational generally can have medical implications both good and bad. But, I think in our culture, MAPS is focused on trying to make sure certain drugs [are made] into medicines for treatment of disease. I think that is where our culture is more likely to process. In some ways there are artificial distinctions between recreational and medical.
HT: Do you think that medical grade MDMA is widely available on the streets for use recreationally right now?
RD: I would say that about half of the Ecstasy you can find right now is bogus. I don’t think that pharmaceutical grade MDMA is widely available, but I do think that it is available and the pills tend to be less pure than the powder. This is kind of ironic because the powder you would think is easier to cut with stuff. But on the other hand, it seems that people who have the pill pressing machines tend to be more organized crime and they tend to care less about quality. The powders tend to be made by people who are doing it more because they care about the drug experience, you know they’re not organized crime, they care more about purity so that’s just the way it tends to be. The powders tend to be more pure. We had an Ecstasy pill testing program that various donors gave where people could send Ecstasy pills in anonymously to a DEA licensed lab and have them analyzed. About 900 pills were tested and it cost almost 100,000 dollars. And that’s why we can say that a substantial amount of them are bogus. More and more, you know these little chemicals they have that you can drop on the pills and they turn certain colors? Well, those are made to turn certain colors in the presence of MDMA, but now, unscrupulous manufacturers are making pills that are one part MDMA and nine parts caffeine. But they still test positive with these test kits.
HT: Is caffeine one of the most common adulterants?
RD: Yes, caffeine is quite common. Also, people put in methamphetamines at times, all sorts of stuff. Never really found heroin, all those rumors and we never found it. A lot of misinformation. The Ecstasy pill testing program is unfortunately right now temporarily shut down until we can find new donors. This was done with MAPS, Erowid, and DanceSafe.
HT: Back to the medical MDMA testing. Who would be an ideal candidate for this therapy?
RD: It tends to be somebody who has an intense powerful emotional issue. So, there are certain people who have a genetic based depression or schizophrenia and things like that. Most likely MDMA could be effective with schizophrenia or depression, it is organically based. But, the ideal kind of person for MDMA has basic difficult powerful emotions. Someone facing terminal illness, you know. MDMA is great for relationships; that’s why people take it at raves all the time, it’s really great for marital therapy. MDMA for PTSD. MDMA in half doses for meditation. There are so many uses. MDMA for prisoner rehabilitation…
HT: Is there any danger of addiction?
RD: Yeah, there is a low potential of addiction. It’s not really like a high potential, there is a danger, but it turns out that a lot of people who start doing MDMA too much start developing a tolerance to it, then they start upping their dose and then you get to this point, like 300 or so milligrams, quite a lot, the normal dose during therapy is 125 milligrams, and then two hours later like half as much, like 62 and a half, but there are people who take 300 milligrams at a time. When you try to take MDMA in higher doses, you tend to get more of the amphetamine effect, and not as much of the clarity and the emotional depth and so people get tolerance to it, but not the kind of tolerance where you up the dose and get the same experience. So it tends to be self limiting for most people how frequently they do MDMA. There are people who do it for years, there are people who do it every weekend for years, there is a potential for addiction. But relatively, a low number of people abuse it. Then when they do use it that much sometimes people can get depressed, exhausted, not much sleep, not feeling well, all sorts of things, but when they give it up there emotions tend to go back to normal after a while.
HT: What is the connection between inanimate chemicals and complex human emotions?
RD: It’s like building blocks, you know, chemicals; we’re all physical beings with vitamins and minerals and all sorts of stuff. It’s the apparatus that permits us to have feelings; it’s like saying “what’s the connection between the television set and the TV show?” You don’t have the show without the TV, but the show is deeper and more complex than the TV.
HT: So are such connections scientifically quantifiable?
RD: To some extent, yeah. I mean, it’s going to be difficult to say this feeling you had came from this part of the brain and these chemicals you took. That sort of makes it, reduces it, to all about the physical stuff when I think there is a lot of choice, free will, emotions, higher things that are built off the physical structure, a sub-structure, like a skeleton, we have a skeleton but how it moves and, well without the physical sub-structure we wouldn’t be people, we wouldn’t be here, but there is more going on than just that.
HT: Would it ever be advisable for a therapist to take MDMA along with a patient?
RD: I’d say it is conceivable, I’d say in general no. In general you want it to be about the patient. You can have empathy with the patient and understanding and be helpful without being under the influence yourself. Some therapists when they would work with people would take 40 milligrams, a low dose, because it helped their attention and gave them a certain alertness and somewhat in tune, but I think in general the therapist provides a safe place, sort of just grounding and stays straight and helps the people through their own experiences rather than joining them on a common experience.
HT: How much does the research going on with MDMA for PTSD cost?
RD: Well, it’s about 400 thousand for the study down in Charleston. To make MDMA into a medicine it’s going to take five million dollars over five years.
HT: Where do you receive your funding?
RD: We have about 1,500 members that send in money and some of them are family foundations that send in a lot. You know, we have a small number of large donors and a large number of small donors.
HT: Does anyone stand to make a profit when MDMA becomes a prescription drug?
RD: We’re doing it in a non-profit context. Pharmaceutical companies aren’t trying to do it because it competes with their own drugs. Therapists will make money delivering the therapy. The key point is that MAPS is doing this in a nonprofit context. There are so many political difficulties. The drugs are not patentable; the drugs are only given a few times in therapy, that really it would break any case that we should invest in this because there will be profit at the end.
HT: What stage of the research are you in?
RD: Phase two. Phase one is basic safety studies, phase two you start doing preliminary studies into efficacy, and then phase three is a large scale study where you try to prove safety and efficacy. So those are the studies that have hundreds and hundreds of people and take years to do. So we’re not there yet. We hope to be there within a year.
HT: Do you hope to see medical MDMA available by prescription from your family doctor in the foreseeable future?
RD: No. It’s five million dollars over five years, and then it is never going to be prescribed by a family doctor. That’s a lot of what my PhD dissertation was about. I think that it most likely will be permitted only in special psychedelic clinics. Like a hospice center, or a birthing center, or a nursery center, they are like regulated environments where doctors and therapists with special training will, like a methadone clinic, but not exactly because you get the methadone and then you go off on your own. Psychedelics are drugs that will be administered under supervision, they’ll spend the night at the clinic, and they’ll have therapy the next morning, and then they’ll go home.
HT: Did you ever have a personal connection to pursuing treatment for PTSD that led you into the research of MDMA or visa versa?
RD: A friend of mine’s girlfriend had emotional… had been depressed, had been suicidal, had been raped, and had PTSD. And under the influence of MDMA she started feeling worse. She had actually put it out of her mind, a lot of it, and when she did the MDMA it came to the surface and she actually wasn’t in the place to deal with it and felt worse and contacted me, this is back in 1984, and so I ended up working with her with MDMA in a safe place and it really helped her a lot. So I’ve never had PTSD myself, but I have worked directly with people with PTSD, you know 21 years ago, and that led me to really understand the potential of it to treat PTSD and that’s why in part we have that study today.
HT: How severe have cases of PTSD been and still shown positive response to the MDMA treatment?
RD: Severe, very severe, have shown positive response.
HT: MAPS also conducts research on medical marijuana. Have there been any studies on marijuana’s effectiveness as a treatment for PTSD?
RD: I don’t think it’s ideal. There is a team of researchers in Israel that is going to be looking at marijuana for PTSD, but I think something more like MDMA, more like a psychedelic, will be treating Post Traumatic Stress Disorder.