Big Think: MDMA and Ayahuasca in Ritual and Therapy

Summary: Big Think interviews psychedelic research pioneer Dr. Charles Grob about the history and future of psychedelic research, the necessity of ritual in understanding the uses of certain psychedelics, and the role psychedelics may play in transforming mental health.

Originally appearing here.

In 2002, the prestigious journal, Science, published a research paper written by a team led by Johns Hopkins researcher, George Ricaurte, stating that MDMA can be neurotoxic in a single dose. Ricaurte had long been critical of MDMA; his research in the eighties helped the US government decide to label it a Schedule 1 drug, despite the trial judge stating that it should remain legal for clinical testing. (The newly appointed DEA head overturned the judge’s decision.)

Ricaurte’s research on squirrel monkeys seemed to seal the coffin: ecstasy can permanently damage your brain in a single dose. The meme that information spawned persists today. The problem is that Ricaurte used methamphetamine, not MDMA. Though the study was retracted by Science, Ricaurte has not gone to great lengths to admit his mistake. In fact, he claimed the facility that sent him the drug mislabelled the vials; the facility says that’s bogus.

At every step along the way, Dr. Charles Grob has provided a clearer story. The professor of Psychiatry & Biobehavioral Sciences and Pediatrics and Director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center testified in front of Congress in the eighties; he has written extensively about the science and politics of ecstasy, among other psychedelics. As the first researcher granted FDA approval to clinically test ayahuasca and MDMA, Grob’s work provided the foundation of the renaissance in psychedelics research occurring today.

I recently chatted with Dr. Grob about the history and future of research in this exciting field. We discussed the necessity of ritual in understanding the uses of certain psychedelics, as well as potential therapeutic applications being studied now. No proper history of psychedelics research would be complete without a discussion of Grob’s groundbreaking work. He was a pleasure to chat with about the ongoing reformation of our mental health model and the role psychedelics will play in it.

Below is an excerpt of our conversation; you can read the full transcript here.

Derek: Your work in the realm of psychedelics in general and MDMA specifically has been so important over the decades. Having taken an interest in this field in the early seventies thanks to Stanislov Grof’s work, how do you feel about the current state of psychedelics and how people are really taking to them now?

Charles: I’m very pleased that the level of research has significantly improved. There are more studies being developed; more investigators jumping through the necessary hoops, getting all the necessary approvals and funding. We’re seeing a renaissance in psychedelic research. That’s very encouraging and very validating. It’s essentially what I and my colleagues perceived many decades ago: that psychedelics held great promise and potential as a very novel treatment model, and, in particular, applicability for conditions that don’t respond to conventional treatments.

Derek: You were around when MDMA became a Schedule 1 drug. Do you remember at that time why the government took such a hard stance on this particular substance?

Charles: MDMA became scheduled in the mid-eighties. From the early to the mid-eighties, MDMA had gone from a virtually unknown drug or a drug known only to a relatively modest number of psychotherapists who were using it in treatment. Then it suddenly became available out in the public, particularly at dance clubs. I think that trend started in Dallas, Texas in the early eighties. Its use rapidly increased and, most assuredly, alarmed public health authorities and drug enforcement authorities who then moved to put the brakes on.

There was also some early controversy about whether or not MDMA might be neurotoxic to serotonergic neurons in the brain. I think much of this concern was later put to rest, but it was a factor in the decision by the DEA in the mid-eighties to schedule it. Actually, the administrative law judge for the DEA recommended that MDMA be placed in a category where there were some restrictions, but where it could still be utilized for treatment. However, his decision was overruled by the director of the DEA at that time.

It was made a Schedule 1 drug, where except for a three-month period in late 88 / early 89 when a Harvard psychologist named Lester Grinspoon appealed the scheduling. Except for that three-month hiatus, it’s been a Schedule 1 drug ever since.

Derek: That was also partly due to George Ricaurte’s work, which I know you’ve been critical of. Could you speak to whether or not MDMA has any neurotoxic effects, and if not, what are some of the best therapeutic applications you’ve seen evidence of so far?

Charles: The neurotoxicity debate became very vociferous through the 1990s. It really slowed considerably the development of human research in general. Myself and some of my colleagues were highly critical of some of the studies contending to demonstrate that MDMA was neurotoxic in humans. However, our voices were not heard until the early two-thousands when the Ricaurte group published an article in Science, a very prestigious journal, reporting that when high doses of MDMA were injected repeatedly into squirrel monkeys. These squirrel monkeys were eventually sacrificed and their brains autopsied and examined. Not only was their serotonergic damage identified, but also damage to the dopaminergic neurotransmitter system.

The implications of that were very worrisome because dopamine neurotoxicity might very well lead to a high risk of developing Parkinson’s disease over time. However, there’s never been a clinical correlation between MDMA and Parkinson’s. What’s more, a year after this article was published in the early two-thousands, a retraction was published in Science stating that it actually was not MDMA that the monkeys had been injected; rather it was methamphetamine. Evidently there had been a mislabeling of the vials containing the drug. Whether or not that was the actual reason, I don’t know. But that was the reason given for why it was methamphetamine and not MDMA. And after that point, there’s been very little interest or even activity trying to demonstrate that MDMA causes neurotoxic brain damage.

Of course, that being said, I think it’s important to point out that with a drug like MDMA, which does have very strong central nervous system effects, less is best. It’s not a lifestyle drug, in my opinion. If used at all, perhaps only sparingly, and for an important reason, such as treatment of PTSD, which Michael Mithoefer’s group has shown MDMA to be quite effective with.