It's not, actually. I've heard interviews with researchers in other MDMA studies saying that there were subjects who were absolutely convinced they got MDMA, and acted like they were on it, but when the double-blind study was over it was revealed that they didn't.
Never underestimate the power of placebos or of the human mind.
https://pubmed.ncbi.nlm.nih.gov/17484949/
His blood pressure crashed (80/40 initally, 100/62 after several hours of IV fluids) and his heart rate was over 100 bpm. When he found out the pills he had taken were inert, he bounced back almost immediately.
- Blood pressure tends to shoot up, rather than down, during a panic attack.
- Four hours would be incredibly long; they're usually more like 20 minutes
But if you've ever done MDMA you'd certainly know it was a placebo, so it feels like these are people who never had, but imagined what they thought it ought to be like.
I'd actually be incredibly curious to hear their description of it? Especially since everyone knows what people act like when drunk or on cocaine... but I'm not quite sure people have as definite an idea of MDMA?
I don't know about this couples therapy thing, but remember that in most of this trials researchers are dealing with somehow of an "unstable" brain chemistry. Individuals with PTSD or ASD tend to dissociate even when sober and to be very sensitive to mindset and setting and believing they took a pill that is going to make their struggles go away while talking with a therapist can be a very warm and welcoming setting.
That being said, I also would like to point out that how people act on cocaine is usually heavily misunderstood and most of the stereotype of someone under the influence of cocaine is usually how people act on cocaine+some other strong stimulant like pseudo-efedrine. Cocaine was used medically for a long while and it's effects are very well understood and not similar to the usual "that person is on coke" stereotype.
I think it's like hypnosis - they say that just allows people to do what they want to do anyways. It's just permission to act differently and that be OK.
What's the dose used in the experiment? Similar to a recreational dose, or much smaller? If it was much smaller, i could imagine people not really being able to tell.
EDIT: The paper [1] says there are two MDMA 'sessions', about three weeks apart, and:
> Each partner was given 75 mg MDMA in the first MDMA session, and 100 mg in the second MDMA session, with an optional supplemental half-dose 1.5 hours later in both sessions (participants were informed that the supplemental half-doses could prolong the therapeutic window of MDMA effects).
I am told that a typical recreational dose of MDMA is 100 mg. More concretely, an Orange Tesla is ~250 mg, so make of that what you will.
[1] https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1...
There have been times when the effect of coffee or marijauna hits me after a few sips/a bite of an edible, which feels placebo-y. But then I'm aware that it seems to be too fast, even as I start to feel it so fast, so could that still be a placebo effect?
I don't know, but it confuses me.
My only guess is that some of the THC is absorbed orally, but in a small quantity. That might explain the high feeling. Can't say I would know what the mechanism for this is, just a guess.
Experiencing an unusual taste in the mouth is common. I've heard of some people feeling a need to vacate their bowels when they are anticipating taking a drug.
So it's not at all surprising that when you actually take a drug you experience something right away, even before the drug has had time to work.
The mind is a powerful thing.
This is a completely untested hypothesis, but I wonder if these kinds of effects are somehow related to hallucinogen persisting perception disorder (HPPD). People experience some really powerful effects under the influence, and maybe the mind somehow learns to reproduce some of these effects on its own.
Not sure how based in reality that is, but seems to imply a similar effect for other drugs might be real.
I strongly suggest with little evidence that if you took 10 people who had previously taken MDMA and gave them placebos at least 9 would know it if not all 10. A single digit percentage of the control who don't know they got a placebo probably renders it pretty useless.
The BBC did a doco [1] on MDMA as a symptom mitigator for parkinson's disease with a stuntman who had it bad but liked to party at music festivals and saw it completely alleivated the symptoms. They did the two trials thing with him, take a pill (once mdma, another time placebo) and try to perform specific tasks in a gym and grade how well he could do it. The cameras got him saying something like this to the boffins in white coats: "I know this is the real thing because I can do it all easily and THE MUSIC ISN'T LOUD ENOUGH!!!"
[1]https://www.bbc.co.uk/science/horizon/2000/ecstasyagony.shtm...
The same happens when you take a paracetamol, you always feel better as soon as you've taken it, but it's because previously it did really work.
A similar thing happens with cursing - you can put up with more pain while shouting swear words than normal words, it is believed that is because you associate all those swear words with previously painful/traumatic times in your life and you're kind of drawing on those for extra strength.
The brain is strange and marvellous.
The problem then becomes the "nocebo" effect, wherein the patients who know they haven't been dosed with a powerful psychoactive substance assume that their treatment will be ineffective, and therefore stop giving it the required effort.
With therapy, it's important that the patient be onboard with and believe in the therapy. Giving people obvious placebos is a reliable way to lower expectations and instill doubt.
My best guess is that it was at a video of a talk or interview given on the Aware Project[1], or on an episode of the Psychedelic Salon[2]
[1] - https://www.youtube.com/channel/UC0oErWkP157InE47YAuhzPg
What's the difference between this and being prescribed an antidepressant? I'd argue there is no difference except that self-medicating is much less likely to work.
I don’t mean to attack MDMA. I think it’s great, and a lot of people could benefit from it. But I think this is a real issue if it’s easily available outside of a therapeutic context.
Does that mean you are now doing it more frequently than every 4 months? If so, how often are you taking it?
Antidepressants don't provide immediate relief. In fact, one of the major challenges with antidepressants is that they require time to work, some times as much as a month or more for full effect. They also don't directly induce "good" feelings, rather they work to dampen negative feedback loops and give the patient space to sort out their problems.
Another challenge with antidepressant treatment is that patients frequently fail to associate their improvements with the medication. It's very common for patients to discontinue their medication because they think they don't need it any more, only to discover that the medication was part of their recovery all along.
MDMA treatment, on the other hand, is solely about immediate effects. The patient feels the effects very quickly and there is no question about where those good feelings came from. The trap is that those drug-induced feelings are entirely unsustainable. MDMA is even notorious for extreme rebound effects, known as "suicide Tuesday". People who attempt to use MDMA frequently will quickly succumb to tolerance and dependence, becoming mentally far worse than when they started. The only reason it's being considered for therapy is that they're using lower doses relative to what most recreational users use, and the administration is limited to two therapy sessions under strict control. Users go into this with the expectation that they must use the drug as a tool to help their therapy work, not that they can use the drug as a go-to to fix their problems.
"I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they've always worked for me."
— Hunter S. Thompson
That's why these successful programs are always therapy-first, rather than drug-first. The focus is first on identifying and fixing problems, using drugs to potentially amplify the therapy rather than avoid the problems.
Sadly, most of these studies lack any control groups (e.g. therapy-only) to compare against. If you look at the graphs in the study, patients were already reporting massive improvements after the first 3 therapy sessions, before taking any MDMA at all. Unfortunately, I don't think we can draw any conclusions about the MDMA in this study other than it didn't appear to make things worse when it was introduced.
Morphine is a medicine until you take like a drug. MDMA is a psychedelic at a rave and a medicine on a therapist's couch. By all reports, there's no possible way to abuse ayahuasca.
You will have more mileage with someone experienced, and more still with a professional, just like you would with other therapy practices that you can teach yourself, like meditation and yoga.
AFAIK addiction is mostly about a person's life, and not the things they ingest. That's why rehab clinic success is so heavily dependent on the support network (or lack thereof) the person returns to. You have to have something to avoid in the first place to turn to substances to avoid them.
I don't know where you heard this, but this is a highly dubious assertion.
I know people who have in fact abused ayahuasca, take it compulsively, and have had negative impacts on their life from taking it.
There's a long and sad history of various drugs being claimed to be harmless or even beneficial, only to have it revealed later that they aren't.
Cocaine was such a drug, with Freud being a huge fan of it, claiming it as a miracle cure with no potential for abuse. In fact it was used to treat morphine addiction.
Heroin was also initially used as a treatment for morphine addiction.
The methadone came around, and was used to treat heroin addiction. But, surprise! It turns out that just like heroin and cocaine, methadone itself can be addictive.
Marijuana was widely hyped as completely harmless, but it turns out that some people can get (psychologically) addicted to it, abuse it, and suffer negative effects.
Anything (whether drug, activity, object, or food) that is highly desirable can be abused.
That's a little unfair to methadone. It is less addictive than heroin and morphine. But users figured out how to combine it with other drugs to get a stronger high, which led to some recreational abuse. It's sad that these maintenance programs are so widely disparaged when they are in fact valuable treatments for opioid use disorder supported by extensive medical evidence that are underutilized due to popular misconceptions and paranoia.
https://jamanetwork.com/journals/jama/article-abstract/18289...
I am super interested in hearing more details. Can you share?
The other person was a compulsive liar and kept on jumping from cult to cult until they landed in an Ayahuasca christian sect saying they were very experienced trip guides. After a few months of "secretly" doing it I assume to understand how it worked to be able to deliver on their promises they got discovered and kicked out.
Psychedelic mania or psychedelic psychosis is a thing. I don't think any substance that affects your perception in such a way will ever be free from that nasty side effect. There's people that actually binge smoke DMT multiple times per week because they really believe they are in contact with spirits and start acting that narrative with life changing consequences. The incorrect social circle or antisocial tendencies will turn that person into a monster living in hell. And if you don't know about smoking DMT let's say that making sense of the experience requires a great deal of... interpretation. Of the psychedelics it's one of the ones that will on most cases hardly create anything that is even mildly similar to reality in the "breakthrough" world.
Speaking from personal experience, microdosing was something that I wanted to push to the limits of being a microdose until it became a "minidose". I was a bit relieved when I lost my stash (due to my own drugged up incompetence), it was becoming a way to just slightly trip out two times a week. As strong as a full blown DMT experience can be, people abuse all sorts of substances with scary effects from solvents, to cough syrup, to Salvia.
It absolutely was not. I'm a caffeine addict and my life is a lot better for it, as far as I can tell.
There's a continuous gradient between "medicine", "habit", "functional addiction", and "rock bottom addiction". It's hard to draw defining lines on other peoples' spectra.
False equivalency is a massive problem in online drug discourse. It's not helpful to lump all substances into a single "drugs" category and then draw conclusions by cherry-picking specific substances like caffeine. We have plenty of evidence that caffeine is safe to consume regularly over the long term. Trying to consume MDMA at a similar frequency would provided disastrous long-term effects. It's disingenuous to try to equate the two substances.
> There's a continuous gradient between "medicine", "habit", "functional addiction", and "rock bottom addiction". It's hard to draw defining lines on other peoples' spectra.
It's not really as arbitrary as you make it sound.
The bigger problem is that addicts almost always fail to categorize their own usage, especially in the early phases. It's frighteningly common to hear addicts rationalize their escalating addictions as self-medication, or for alcoholics to convince themselves that they are functional alcoholics as their lives slowly fall apart.
Everyone on this planet does things to alter their mental state and status, from running, to masturbation, to coffee, to meditation, to SSRIs from the pharmacy, to drink, to cigarettes, to recreational illicit stimulants like cocaine, to intravenous heroin from the streetcorner. I could plot a continuous curve between the extremes, and it isn't any of our place to say where "therapy" ends and "addiction" starts for any other person, because of the wide range of procedures, practices, frequencies, dosages, and effects, both positive and negative.
I can definitely see how it could help couples talk through their difficulties and it seems to bond people closer together.
As an aside I know a guy who completely fucked himself by doing mdma farvto much. It was really sad to meet him after a few years, he'd gone from happy outgoing to a paranoid mess.
> As an aside I know a guy who completely fucked himself by doing mdma farvto much. It was really sad to meet him after a few years, he'd gone from happy outgoing to a paranoid mess.
The public discourse on MDMA is in a strange place. Many people desperately want to believe that it doesn't have negative consequences, but anyone who has watched acquaintances go downhill with repeated MDMA use knows that it's hardly free of side effects. The problem is that internet commenters will quickly come up with any and every excuse to dismiss negative studies, anecdotes, and evidence. The usual strategy is to blame polydrug abuse or imply that the drugs were somehow impure.
People can fuck themselves up on any substance if abused, that friend may be able to undo the damage done with MDMA via Ayahuasca ceremonies - perhaps via the neurogenesis that is seen with Ayahuasca use to recreate pathways that may have been lost due to excessive MDMA use. Not a doctor.
That’s a recipe for addiction, more so than anything else.
MAPS does pretty much all of the coordination with the FDA and other regulatory bodies for making these studies possible.
This happens with any substance if a person isn't actually working through the issues that lead to them wanting to "escape" temporarily. However MDMA does have the function of actually giving people access to suppressed-repressed trauma/stress, and once having access makes it easier to process/heal - this is why it's powerful to eliminate PTSD.
This false equivalency is a common trap for people who end up with chemical dependencies. Just because people can get addicted to less addictive substances doesn't mean that we can ignore the fact that some substances are more addictive than others.
As usual, it's important to emphasize that this research is about therapy, with MDMA as an additional modulator on top of the therapy. In this case, 15 therapy sessions over a period of 7 weeks. MDMA was only involved in 2 of the 15 sessions. If I'm reading the paper correctly, patients received 3 therapy sessions before MDMA was introduced and the bulk of reported improvements happened prior to MDMA being added. Looking at the graphs, there aren't any obvious score increases around the MDMA sessions. In fact, I couldn't tell when the MDMA was introduced without reading the methodology section.
The study was also limited to 6 couples, with no control group. Note that the control group in this case doesn't have to be a placebo group, because it's too obvious if someone has taken a powerful drug. Instead, the control group would simply receive therapy without MDMA and results would be compared. The difference would begin to show the benefit of therapy+MDMA over therapy alone, which is critically important in these trials. You can't just give people 15 therapy sessions and then attribute the benefits to 2 doses of MDMA.
People tend to see these headlines and assume that the drug is doing all the work, or that they can simply replicate the results by taking the drug and seeing what happens. This is usually backed up by a couple of random positive anecdotes in the comment section while anyone with negative experiences is downvoted or dismissed.
Please don't assume you can replicate these results with ad-hoc experimentation with street drugs. If you browse Reddit, it's not hard to find anecdotes from people who have mistaken the short-term effects of these drugs for long-term healing, which usually results in them reaching out for more drugs the next time they have problems. Once people convince themselves that the drug is the easy solution to their problems, they're on their way to low-level addiction.